Prompting system and method for enhancing learning with neural modulation

ABSTRACT

Systems and related methods for enhancing learning of an activity by a subject are described. A prompt for causing the subject to perform the activity is delivered repeatedly, in combination with a neural stimulus, with timing of delivery of prompts and neural stimuli controlled by electrical control circuitry. Neural stimuli are delivered with a transcutaneous neural stimulator located fitted in or on at least a portion of an ear of the subject. The system is implemented in connection with a personal computing device such as a smart phone or tablet computer.

If an Application Data Sheet (ADS) has been filed on the filing date ofthis application, it is incorporated by reference herein. Anyapplications claimed on the ADS for priority under 35 U.S.C. §§ 119,120, 121, or 365(c), and any and all parent, grandparent,great-grandparent, etc. applications of such applications, are alsoincorporated by reference, including any priority claims made in thoseapplications and any material incorporated by reference, to the extentsuch subject matter is not inconsistent herewith.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of the earliest availableeffective filing date(s) from the following listed application(s) (the“Priority Applications”), if any, listed below (e.g., claims earliestavailable priority dates for other than provisional patent applicationsor claims benefits under 35 USC § 119(e) for provisional patentapplications, for any and all parent, grandparent, great-grandparent,etc. applications of the Priority Application(s)).

PRIORITY APPLICATIONS

None.

If the listings of applications provided above are inconsistent with thelistings provided via an ADS, it is the intent of the Applicant to claimpriority to each application that appears in the DomesticBenefit/National Stage Information section of the ADS and to eachapplication that appears in the Priority Applications section of thisapplication.

All subject matter of the Priority Applications and of any and allapplications related to the Priority Applications by priority claims(directly or indirectly), including any priority claims made and subjectmatter incorporated by reference therein as of the filing date of theinstant application, is incorporated herein by reference to the extentsuch subject matter is not inconsistent herewith.

SUMMARY

In an aspect, a system for enhancing learning of an activity includes,but is not limited to, a housing configured to fit in or on at least aportion of an ear of a subject, a neural stimulator located in or on thehousing and configured to deliver a transcutaneous neural stimulus to aperipheral neural structure located at least in part in or on the ear ofthe subject, a prompting system configured to deliver at least oneprompt for prompting the subject to repeatedly perform a specificactivity, and electrical control circuitry including stimulator controlcircuitry adapted to generate at least one stimulus control signal forcontrolling delivery of the transcutaneous neural stimulus to theperipheral neural structure with the neural stimulator, prompter controlcircuitry adapted to generate at least one prompt control signal forcontrolling delivery of the prompt by the prompting system, and timingcontrol circuitry for controlling a number of repetitions of thespecific activity that the subject is prompted to perform by the atleast one prompt and timing of delivery of the transcutaneous neuralstimulus with respect to the at least one prompt. In addition to theforegoing, other system aspects are described in the claims, drawings,and text forming a part of the disclosure set forth herein.

In an aspect, a method of enhancing learning includes, but is notlimited to, delivering, with a neural stimulator housed in a housingfitted in or on at least a portion of an ear of a subject, atranscutaneous neural stimulus to a peripheral neural structure locatedat least in part in or on the ear of a subject, wherein the neuralstimulator is controlled by electrical control circuitry operablycoupled to the neural stimulator; delivering, with a prompting systemunder control of the electrical control circuitry, at least one promptto the subject for prompting the subject to repeatedly perform aspecific activity, wherein the electrical control circuitry is operablycoupled to the prompting system; controlling, with the electricalcontrol circuitry a timing of delivery of the transcutaneous neuralstimulus with respect to the at least one prompt; and a number ofrepetitions of the specific activity that the subject is prompted toperform by the at least one prompt. In addition to the foregoing, othermethod aspects are described in the claims, drawings, and text forming apart of the disclosure set forth herein.

In an aspect, a computer program product includes, but is not limitedto, at least one non-transitory computer-readable medium bearing one ormore instructions for generating, under control of electrical controlcircuitry, a least one stimulus control signal for controlling deliveryof a transcutaneous neural stimulus to a peripheral neural structurelocated at least in part in or on an ear of a subject via a neuralstimulator fitted in or on at least a portion of the ear of a subject;one or more instructions for delivering, via a prompting system undercontrol of the electrical control circuitry, at least one prompt forprompting the subject to repeatedly perform a specific activity; one ormore instructions for controlling a timing of delivery of thetranscutaneous neural stimulus with respect to the at least one prompt;and one or more instructions for controlling a number of repetitions ofthe specific activity that the subject is prompted to perform by the atleast one prompt. In addition to the foregoing, other aspects of acomputer program product are described in the claims, drawings, and textforming a part of the disclosure set forth herein.

In an aspect, a system for enhancing learning includes but is notlimited to, a noninvasive device for stimulating a cranial nerve of asubject, the device including at least one transcutaneous nervestimulator; at least one neural sensor adapted to sense at least oneneural activity of the subject; a prompting system configured to deliverat least one prompt for prompting the subject to repeatedly perform aspecific activity; and electrical control circuitry including stimulatorcontrol circuitry adapted to generate at least one stimulus controlsignal for controlling delivery of a transcutaneous neural stimulus tothe cranial nerve with the transcutaneous neural stimulator; promptercontrol circuitry adapted to generate at least one prompt control signalfor controlling delivery of the prompt by the prompting system; andtiming control circuitry for controlling a number of repetitions of thespecific activity that the subject is prompted to perform by the atleast one prompt and timing of delivery of the transcutaneous neuralstimulus with respect to the at least one prompt. In addition to theforegoing, other system aspects are described in the claims, drawings,and text forming a part of the disclosure set forth herein.

The foregoing summary is illustrative only and is not intended to be inany way limiting. In addition to the illustrative aspects, embodiments,and features described above, further aspects, embodiments, and featureswill become apparent by reference to the drawings and the followingdetailed description.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 illustrates a system for enhancing learning.

FIG. 2 is a block diagram of a system for enhancing learning.

FIG. 3 is a block diagram showing further details of the system of FIG.2.

FIG. 4 is a block diagram of a circuitry-based system.

FIG. 5 is a flow diagram of a method of enhancing learning.

FIG. 6 is a flow diagram of a method.

FIG. 7 is a flow diagram of a method.

FIG. 8 is a flow diagram of a method.

FIG. 9 is a flow diagram of a method.

FIG. 10 is a flow diagram of a method.

FIG. 11 is a flow diagram of a method.

FIG. 12 is a flow diagram of a method.

FIG. 13 is a block diagram of a computer program product relating to themethod of FIG. 5.

FIG. 14 depicts an embodiment of a system for enhancing learning.

FIG. 15 depicts a training system.

FIG. 16 depicts another embodiment of a training system.

FIG. 17 is a flow diagram of a method for training a subject to performa task.

FIG. 18 is a flow diagram of a method.

FIG. 19 is a flow diagram of a method.

FIG. 20 is a flow diagram of a method.

FIG. 21 is a flow diagram of a method.

FIG. 22 is a flow diagram of a method.

FIG. 23 is a flow diagram of a method.

FIG. 24 is a block diagram of a computer program product relating to themethod of FIG. 17.

FIG. 25 depicts a learning system for enhancing learning of a soundpattern.

FIG. 26 is a block diagram of a method of enhancing learning of a soundpattern.

FIG. 27 is a flow diagram of a method.

FIG. 28 is a flow diagram of a method.

FIG. 29 is a flow diagram of a method.

FIG. 30 is a flow diagram of a method.

FIG. 31 is a block diagram of a computer program product relating to themethod of FIG. 26.

FIG. 32 is an illustration of a system for enhancing learning of a motortask.

FIG. 33 is a flow diagram of a method of training a subject to perform acomplex motor task.

FIG. 34 is a flow diagram of a method.

FIG. 35 is a flow diagram of a method.

FIG. 36 is a flow diagram of a method.

FIG. 37 is a flow diagram of a method.

FIG. 38 is a flow diagram of a method.

FIG. 39 is a flow diagram of a method.

FIG. 40 is a flow diagram of a method.

FIG. 41 is a block diagram of a computer program product relating to themethod of FIG. 33.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of the subject matterpresented here.

FIG. 1 depicts an example of a system 100 for enhancing learning of anactivity. (In FIG. 1 and other figures herein, system components aredepicted both in an illustration and in block diagram form, to moreclearly show all components and how they interact. Elements that appearin both the illustration and the block diagram are identified with thesame reference number in each). In the example of FIG. 1, the activityis playing a violin 101. System 100 includes a housing 102 configured tofit in or on at least a portion of an ear 104 of a subject 106, and aneural stimulator 108 located in or on housing 102. Neural stimulator108 is configured to deliver a transcutaneous neural stimulus to aperipheral neural structure located at least in part in or on the ear104 of subject 106, for example as described in U.S. Published PatentApplication No. 2016/0279435 to Hyde et al., which is incorporatedherein by reference. System 100 also includes a prompting system 110,implemented on a tablet computer 112, which is configured to deliver atan audio prompt 114, via speaker 116, for prompting subject 106 torepeatedly perform a specific activity (i.e. and activity related toplaying violin 101), and electrical control circuitry 118, whichincludes control circuitry of tablet computer 112 and circuitry ofstimulator driver 120 for driving neural stimulator 108. Stimulatordriver 120 includes additional driver circuitry that may be used incombination with tablet computer 112 to generate a driving signalsufficient to drive neural stimulator 108. Electrical control circuitry118 includes stimulator control circuitry 122 adapted to generate atleast one stimulus control signal 124 for controlling delivery of thetranscutaneous neural stimulus 126 to the peripheral neural structurewith the neural stimulator 108, prompter control circuitry 128 adaptedto generate at least one prompt control signal 130 for controllingdelivery of the prompt 114 by the prompting system 110, and timingcontrol circuitry 132 for controlling a number of repetitions of thespecific activity that the subject is prompted to perform by the atleast one prompt and timing of delivery of the transcutaneous neuralstimulus with respect to the at least one prompt. Specifically,prompting system 110 includes display 140 and speaker 116. As anexample, if system 100 is being used by subject 106 to practice playinga scale on violin 101, audio prompt 114 is a brief tone which promptssubject 106 to play the scale. Neural stimulation is delivered tosubject 106 in fixed temporal relationship with the tone. The tone isdelivered repeatedly, at intervals such that subject 106 plays the scaleonce with each repetition of the tone. Display 140 of tablet computer112 is used to provide instructions to subject 106. For example, aftereach repetition, subject 106 is informed of the number of repetitionsthat have been completed and the number yet to be completed. These andother functions of system 100 and other learning systems are describedherein below.

FIG. 2 is a block diagram of a system 200 for enhancing learning of anactivity, which is a generalization of a system of the type depicted inFIG. 1. FIG. 2 shows additional, alternative, or optional componentsthat may be used in connection with a system as depicted in FIG. 1, orin other systems for enhancing learning, additional examples of whichare described elsewhere herein, with specific examples provided in FIGS.14, 15, 16, 25, and 32.

System 200 includes at least one neural stimulator 202, prompting system204, sensing system 206, and electrical control circuitry 208. Neuralstimulator 202 is used to deliver a neural stimulus 210 to a neuralstructure 212 of a subject 214. Prompting system 204 prompts subject 214to perform an activity. Operation of neural stimulator 202 and promptingsystem 204 is controlled by electrical control circuitry 208.

Neural stimulation is used to enhance learning or memory of a desiredactivity or skill, and, in some cases, block learning of an undesiredactivity. In an aspect, a “desired activity” is correct performance of atask, and an “undesired activity” is incorrect performance of a task,for example, a mental or physical (motor) task. In an aspect, neuralstimulation can be used to enhance or reinforce learning of a desirableresponse to a stimulus, or to block or suppress learning of anundesirable response to a stimulus. A response may be an emotionalresponse, a sensory response, a physiological response, or a reflexiveresponse, for example. In various aspects, systems described herein canbe used for reducing neuropathy (including autonomic neuropathy),tinnitus, sexual dysfunction, and/or neuropathic pain. In variousaspects, systems described herein can be used to learn a new skill orenhance a skill (e.g., playing an instrument, performing a sportsaction, speaking a language, performing a math function) or to re-learna skill, for example during rehabilitation treatment for a braindisorder (e.g., stroke or injury), nerve damage, or other physicaldysfunction. In various aspects, systems described herein can be used toentrain or enhance memory such as for memory recall, to aide inmemorization (e.g., of a verbal, musical, or physical performance;vocabulary; facts; numbers such as a telephone number or combination;mathematical equations; etc.), to learn or enhance cognitive skills(e.g., thinking, reasoning, reading, memory, etc.), and the like. Invarious aspects, systems described herein can be part of a medicaltherapeutic system or regimen administered by a health care provider. Invarious aspects, systems described herein can constitute or be part of arecreational system. In various aspects, systems described herein canconstitute or be part of a consumer product.

Various neural structures can be stimulated to enhance learning,including peripheral and/or cranial nerves as well as selected brainstructures. Methods for delivering vagus nerve stimulation are describedin S. A. Hays, R. L. Rennaker, M. P. Kilgard, “Targeting Plasticity withVagus Nerve Stimulation to Treat Neurological Disease” in M. M.Merzenich, M. Nahum, and T. M. Van Vleet, Editors: Progress in BrainResearch, Vol. 207, Burlington: Academic Press, 2013, pp. 275-299, ISBN:978-0-444-63327-9, which is incorporated herein by reference. Forexample, this reference describes using vagus nerve stimulation inconnection with motor task training (pressing lever and spinning wheelto receive food reward, by rats), cognitive task training (recall ofhighlighted words in paragraph by humans), relearning of sensoryprocessing (remapping sensory cortex to reverse chronic tinnitus) orcorrecting of cognitive dysfunctions (normalizing hypersensitiveresponses to stimuli in PTSD in humans). For example, U.S. PatentApplication 2015/0066104 to Wingeier et al., which is incorporatedherein by reference, describes approaches to delivering transcranialelectrical stimulation to the brain. A. M. Boasso, H.Mortimore, R.Silva, L. Aven, W. J. Tyler, “Transdermal electrical neuromodulation ofthe trigeminal sensory nuclear complex improves sleep quality and mood,”bioRxiv preprint first posted online Mar. 15, 2016; doi:http://dx.doi.org/10.1101/043901, which is incorporated herein byreference, describes transdermal modulation of the trigeminal nerve toimprove sleep, and mood and decrease stress, to improve mental healthand performance. C. K. McIntyre, J. L. McGaugh, and C. L. Williams,“Interacting Brain Systems Modulate Memory Consolidation,” NeurosciBiobehav. Re. 2012, August; 36(7):1750-1762.doi:10.1016/j.neubiorev.2011.11.0001, which is incorporated herein byreference, describes the role of emotional arousal, and correspondingrelease of epinephrine and glucocorticoids on enhancing consolidation oflong term memories (and conversely, disrupting memory consolidation byblocking corresponding hormone receptors). Similarly, blockingactivation or conduction in neural structures associated with emotionalarousal (e.g., the vagus nerve, trigeminal nerve) may serve to limitmemory consolidation. Systems and methods for generating blocks inperipheral neural structures are described, for example, in U.S. Pat.No. to 9,358,374 to Dacey et al., which is incorporated herein byreference. While numerous methods and systems for neural modulation aredescribed here, the description is not exhaustive. Any conventionalmethod and system for modulating (at least partially blocking orstimulating) the activation or conduction of neural structures can beused with the systems and methods described and claimed herein.

In an aspect, neural structure 212 is a cranial nerve. In some aspects,neural structure 212 is located at least in part in or on the ear of thesubject.

In an aspect, neural stimulator 202 is configured to stimulate a cranialnerve innervating an ear of a subject, for example as described in U.S.Published Patent Application No. 2016/0279435 to Hyde et al., which isincorporated herein by reference. Nerves innervating the skin on or inthe vicinity of the ear of the subject include, e.g., the facial nerve(cranial nerve VII), the glossopharyngeal nerve (cranial nerve IX), theauricular branch of the vagus nerve (cranial nerve X), theauriculotemporal branch of trigeminal nerve (cranial nerve V), thelesser occipital nerve (spinal nerve C3), and the greater auricularnerve (spinal nerves C2, C3).

Neural stimulator 202 can includes various types of neural stimuluator,including but not limited to, mechanical 218, electrical 220, magnetic222, electromagnetic 224, acoustic 226, ultrasonic 228, optical 230, orchemical 232 stimulators. In an aspect, neural stimulator 202 caninclude multiple neural stimulators. If multiple neural stimulators areused, they may all be of the same type, or may be of several differenttypes. Neural stimulator 202 can be an implanted stimulator 234, or atranscutaneous stimulator 236. Various types of transcutaneous andimplantable neural stimulators are described in U.S. Published PatentApplications 2015/0360060 to Cartledge et al., U.S. Published PatentApplication No. 2016/0279435 to Hyde et al., and U.S. Pat. No. to9,358,374 to Dacey et al., all of which are incorporated herein byreference. Examples of other suitable implantable stimulators include,for example, ‘Bion’ capsule-type stimulators, as described in U.S. Pat.No. 5,324,316 to Schulman et al., and U.S. Pat. No. 5,515,848 toCorbett, II et al.; flat interface nerve electrodes as described in U.S.Pat. No. 6,456,866 to Tyler et al., and cuff electrodes as described inU.S. Published patent Applications 2015/0073492 to Kilgard et al., allof which are incorporated herein by reference.

A mechanical stimulator may include, for example, a vibratory mechanicalstimulator that delivers a cyclical or vibrating mechanical stimulus tothe skin of the ear of the subject. Vibratory mechanical stimulators caninclude, for example, various types of vibrating mechanical devices,e.g., electromechanical, piezoelectric, movable coil, electrostatic,magnetostrictive, isodynamic, and/or MEMS devices, for example as usedfor manufacturing small-scale speakers and microphones. An electricalstimulator 220 may include, for example, an electrode or electricalcontact designed for contacting the skin surface, for example asdescribed in Rong et al., “Transcutaneous vagus nerve stimulation forthe treatment of depression: a study protocol for a double blindedrandomized clinical trial,” BMC Complementary and Alternative Medicine2012, 12:255, which is incorporated herein by reference. In an aspect,magnetic stimulator 222 includes one or more coil through whichelectrical current is passed to generate a magnetic field. The magneticfield induces electrical currents within the tissue in/around the ear ofthe subject to activate neural structures. In an aspect, neuralstimulator 202 includes an ultrasonic stimulator 228, for example asdescribed in Legon et al., “Pulsed Ultrasound Differentially StimulatesSomatosensory Circuits in Humans as Indicated by EEG and fMRI,” PLOS ONE7(12): e5177. Doi:10.01371/journal.pone.0051177, December 2012, which isincorporated herein by reference. In some aspects, other types of neuralstimulators, such as optical stimulator 230 or chemical stimulator 232are used. See, for example, stimulators described in U.S. Pat. No.8,171,658 to Dacey, Jr. et al., which is incorporated herein byreference.

In an aspect, neural stimulator 202 is located in a housing 238. In anaspect, housing 238 and neural stimulator 202 are configured to adeliver a transcutaneous neural stimulus to a cranial nerve innervatingan ear of the subject; for example, housing 238 is configured to fit ona pinna of the ear of the subject, or at least a portion of housing 238is configured to fit into an ear canal or concha of the ear of thesubject. In some aspects, a neural stimulator is located on an extensionthat is secured to an earbud but extends beyond the ear of the subjectto, e.g. a temple or forehead of the subject. These and other neuralstimulator configurations are described in U.S. Published PatentApplication No. 2016/0279435 to Hyde et al., filed Mar. 27, 2015, whichis incorporated herein by reference. In some aspects, neural stimulator202 is positioned with respect to the head or neck of the subject with aheadband, an earphone, a strap, an adhesive patch, etc. to locate neuralstimulator with respect to a cranial nerve, a peripheral nerve, or abrain structure. In other aspects, a neural stimulator is implantedadjacent a cranial nerve, a peripheral nerve, or a brain structure ofinterest. In an aspect, neural stimuli are delivered to peripheralneural structures to evoke emotional arousal and/or biochemicalcorrelates thereof (e.g., release of norepinephrine and/orcorticosterone). In an aspect, neural stimuli are delivered toperipheral neural structures including nerves of the autonomic nervoussystem (particularly the sympathetic nervous system). In an aspect,neural stimuli are delivered to peripheral neural structures includingsomatosensory and other sensory neural structures.

In various embodiments described herein, neural stimulator is located onan earbud, earpiece, or headphone. Such devices also be used to deliversound to the ears of the subject, for use as a prompt, as describedherein below. Neural stimulator 202 may be located in or on a housing238 that contains communication circuitry for wirelessly communicatingwith other system components, for example a personal computing device(e.g., an audio player, a mobile phone, or a laptop computer). A batterycan be provided in housing 238 to power the device for wirelessoperation. In an aspect, the neural stimulator 202 is positioned withrespect to housing 238 such that when housing 238 is worn on the pinna,neural stimulator 202 is positioned over a specific region of the pinna,e.g., a region of the pinna innervated by a cranial nerve, e.g., thevagus nerve, the facial nerve, the trigeminal nerve, or theglossopharyngeal nerve. Positioning of neural stimulator 202 may beselected based upon knowledge of the innervation of the pinna, forexample, as provided in references texts such as Cranial Nerves inHealth and Disease, by Linda Wilson-Pauwels, Elizabeth J. Akesson,Patricia A. Stewart, and Sian D. Spacey; B C Decker Inc.; 2 edition(Jan. 1, 2002); ISBN-10: 1550091646/ISBN-13: 978-1550091649, which isincorporated herein by reference.

Prompting system 204 is configured to deliver at least one prompt 216.For example, prompt 216 may be used to prompt subject 214 to repeatedlyperform a specific activity. Electrical control circuitry 208 includesstimulator control circuitry 240 adapted to generate at least onestimulus control signal 242 for controlling delivery of the neuralstimulus 210 with the neural stimulator 202. Neural stimulus 210 may bea transcutaneous neural stimulus, as described in connection with FIG.1, or other type of neural stimulus as described elsewhere herein.

At least a portion of electrical control circuitry 208 can beimplemented on a personal computing device 250. In an aspect, personalcomputing device 250 is personal digital assistant, a personalentertainment device, a mobile phone, a laptop computer, a tabletpersonal computer, a wearable computing device (e.g., a fitness band, anitem of clothing, attire, or eyewear incorporating computingcapability), a networked computer, a computing system comprised of acluster of processors, a computing system comprised of a cluster ofservers, a workstation computer, and/or a desktop computer. In variousaspects, personal computing device includes one or more of a portablecomputing device, a mobile computing device, and a thin client computingdevice, for example.

Electrical control circuitry 208 includes prompter control circuitry 252adapted to generate at least one prompt control signal 254 forcontrolling delivery of prompt 216 by the prompting system 204, andtiming control circuitry 256. In an aspect, timing control circuitry 256controls a number of repetitions of a specific activity that the subjectis prompted to perform by the at least one prompt 216, and timing ofdelivery of the neural stimulus 210 with respect to the at least oneprompt 216.

In various aspects, stimulator control circuitry 240 is configured togenerate a stimulus control signal 242 for causing the neural stimulator202 to deliver a neural stimulus 210 continuously during a stimulationperiod or intermittently during a stimulation period. In an aspect,stimulator control circuitry 240 is configured to generate a stimuluscontrol signal 242 for causing the neural stimulator 202 to deliver apulsed neural stimulus, and/or a neural stimulus having a time-varyingamplitude, time-varying frequency, or time-varying envelope. In anaspect, the neural stimulus has waveform, frequency, amplitude selectedto activate particular neural structures to produce a learning enhancingor learning blocking effect, for example as described in B. Fritsch, J.Reis, Keri Martinowich, H. M. Schambra, Y. Ji, L. G. Cohen and B. Lu,“Direct Current Stimulation Promotes BDNF-Dependent Synaptic Plasticity:Potential Implications for Motor Learning,” Neuron 66, pp. 198-204, Apr.29, 2010; Elsevier Inc.; DOI 10.1016/j.neuron.2010.03.035; Y.-H. Kim,J.-W. Park, M.-H. Ko, S. H. Jang, and P. K. W. Lee, “Facilitative effectof high frequency subthreshold repetitive transcranial magneticstimulation on complex sequential motor learning in humans,” (Abstract)Neuroscience Letters, Volume 367, Issue 2, 2 September 2004, Pages181-185; Elsevier Ireland Ltd.,http://dx.doi.org/10.1016/j.neulet.2004.05.113; B. Guse, P. Falkai, andT. Wobrock, “Cognitive effects of high-frequency repetitive transcranialmagnetic stimulation: a systematic review,” J Neural Transm (2010)117:105-122, DOI 10.1007/s00702-009-0333-7; and D. Terney, L. Chaieg, V.Moliadze, A. Antal, and W. Paulus, “Increasing Human Brain Excitabilityby Transcranial High-Frequency Random Noise Stimulation,” The Journal ofNeuroscience, Dec. 24, 2008·28(52):14147-14155,DOI:10.1523/JNEUROSCI.4248-08.2008; all of which are incorporated hereinby reference. The neural stimulus may be delivered according toprogrammed pattern. In various aspects, stimulator control circuitry 240is used to determine a neural stimulus amplitude, frequency, waveform,pattern, or duration. System 200 includes data storage location 244,which in various aspects contains stored preprogrammed stimulus patternsand waveforms as well as stimulus parameter values from which neuralstimuli can be computed. In some aspects, stimulator control circuitry240 modifies stimulus control signal 242 responsive to the subject'stask performance, as discussed in greater detail below.

In an aspect, stimulator control circuitry 240 modulates stimuluscontrol signal 242 in response to an override signal. For example, in anaspect override signal is received via a user input of personalcomputing device 250. In an aspect, override signal is received fromsensing system 206. For example, the override signal can be any sensedsignal indicative of an unsafe condition. In an aspect, the overridesignal originates from a sensor that senses a physiological parameter,such as heart rate. In the event that the physiological parameterindicates an unsafe condition (e.g., the heart rate is too high or toolow), stimulator control circuitry 240 modulates stimulus control signal242 to discontinue production of the neural stimulus. In variousaspects, the override signal indicates improper positioning or poorconnectivity of a stimulation electrode, a system malfunction, or othercircumstances in which continued neural stimulation is eitherineffective or unsafe. In addition to modulating or discontinuing theneural stimulus in response to an override condition (e.g.,physiological parameter indicative of an unsafe condition, improperpositioning, a notification may be sent to the subject and/or to anotherparty regarding the override condition, to prompt the recipient of thenotification to take corrective action, or for inclusion of theinformation in the subject's medical records, for example.

Timing control circuitry 256 is adapted to control the timing ofdelivery of the neural stimulus 210 with respect to the at least oneprompt 216. In an aspect, timing control circuitry 256 is adapted tocontrol the timing of delivery of the neural stimulus 210 with respectto the at least one prompt 216 to cause delivery of the neural stimulus210 prior to delivery of the at least one prompt 216. In another aspect,timing control circuitry 256 is adapted to control the timing ofdelivery of the neural stimulus 210 with respect to the at least oneprompt 216 to cause delivery of the neural stimulus 210 subsequent todelivery of the at least one prompt 216. In another aspect, timingcontrol circuitry 256 is configured to control the timing of delivery ofthe neural stimulus 210 with respect to the at least one prompt 216 tocause delivery of the transcutaneous neural stimulus 210 to overlap atleast partially with delivery of the at least one prompt 216.

In an aspect, timing control circuitry 256 is configured to control thenumber of repetitions of the specific activity that the subject isprompted to perform by generating one prompt 216 for each of the numberof repetitions. In another aspect, timing control circuitry 256 isconfigured to control the number of repetitions of the specific activitythat the subject is prompted to perform by generating a first prompt 216that informs the subject of the number of repetitions and a secondprompt 258 that is repeated once for each of the number of repetitions.In another aspect, timing control circuitry 256 is configured to controlthe number of repetitions of the specific activity that the subject isprompted to perform by generating a first prompt 216 that informs thesubject of the specific activity that is to be performed and a secondprompt 258 that is repeated once for each of the number of repetitions.In an aspect, timing control circuitry 256 is configured to control thenumber of repetitions of the specific activity that the subject isprompted to perform by generating a prompt (216 or 258) at a fixed ratefor a fixed period of time.

In various aspects, prompting system 204 is adapted to deliver anaudio-visual prompt, a tactile prompt, a haptic prompt, or an electricalstimulus (which can produce various sensory effects, depending uponwhere the stimulus is applied). Prompting system 204 may include, forexample, a visible signal source 260 adapted to deliver a visibleprompt, e.g. a display 262 or light 264. In other aspects, promptingsystem 204 includes a sound source 266, for example a speaker 268. In anaspect, prompting system 204 includes at least one electrical stimulator270, mechanical stimulator 272 (e.g. a vibrator 274 or force-applyingelement 276), or olfactory stimulus source 278. In other aspects,prompting system 204 includes an ultrasonic stimulator 280 or variousother stimulators adapted to produce sensory or other consciouslydetectable effects in the subject, e.g., a thermal stimulator 279 orelectromagnetic stimulator 281. In an aspect, prompting system includestwo or more of a display 262, light 264, speaker 268, vibrator 274,force-applying element 276, mechanical stimulator 272, electricalstimulator 270, ultrasonic stimulator 280, olfactory stimulus source278, or other sensory stimulator as described herein.

In an aspect, prompting system 204 is located at least in part in or onthe housing 238. In an aspect, prompting system 204 includes or isimplemented on personal computing device 250. For example, display 262or speaker 268 may be associated with personal computing device 250. Inaddition, a personal computing device such as a cell phone typicallyincludes a vibrator 274 which may be used to provide a haptic stimulusto a subject. In an aspect, prompting system 204 is configured as awearable item 282, for example as a garment or wristband. In an aspect,prompting system is configured for attachment to or mounting in or on aninstrument, implement, article of equipment, or article of clothing, asindicated at 284.

In an aspect, system 200 includes a sensing system 206 for detectingperformance of the activity by the subject. In various aspects, sensingsystem 206 is adapted to detect performance of a mental activity by thesubject, performance of a physical activity by the subject, orperformance of two or more related physical or mental activities by thesubject. In other aspects, sensing system 206 includes sensors adaptedfor sensing parameters not directly related to the activity performed bythe subject, but pertinent to control of stimulation or other aspects ofoperation of system 200. Sensing system 206 includes one or moresensors, including, for example, at least one of a neural sensor 290(for example, an EEG sensor 292, an ENG sensor 294, an EOG sensor 296),an EMG sensor 298, a motion sensor 300, a pressure sensor 302, a forcesensor 304, an accelerometer 306, an inclinometer 307, a camera 308, aKinect 310, a scanner 312, an optical sensor 314, a microphone 316, atemperature sensor 318, physiological sensor 320, a location sensor 322,any eye tracking sensor 324, an attention sensor 326, or anenvironmental sensor 328. In various aspects, sensing system 206includes one or more of an implantable sensor 330, a wearable sensor332, a sensor carried by the subject (334), a sensor in or on aninstrument, implement, or article of equipment carried by the subject(336), or a remote sensor (338). In some aspects, a neural sensor 290 ishoused with neural stimulator 202. In other aspects, a neural sensor 290is housed separately from neural stimulator 202, but may be operativelyconnected to the neural stimulator 202 and/or other system componentsvia a wireless connection.

In an aspect, sensing system 206 includes one or more attention sensor326 that can be used to detect parameters indicative of attentiveness ofthe subject. Such sensors include, for example, eye tracking sensors 324(including image processing based sensors, including imagers, laserscanners, 3D scanners; or EOG based sensors), EEG sensors 292 fordetecting electrical correlates of attention, various types of sensorsadapted to detect physical activity of the subject that correlates toattention, including but not limited to an EMG sensor 298, a motionsensor 300, a pressure sensor 302, a force sensor 304, an accelerometer306, or an inclinometer 307. In some aspects, inattention of the subjectmay be indicated by a decline in performance, inconsistent movement,etc. Attention tracking sensors can include wearable sensors, or remotesensors. In various aspects, sensing system 206 includes one or moresensor for detecting parameters that correlate directly with theactivity being learned. In other aspects, sensing system 206 includesone or more sensors that provide information from which the activity canbe inferred. In some aspects, sensing system 206 includes sensors fordetecting parameters used for controlling delivery of neural stimulationcan be sensed, for example, with physiological sensors, environmentalsensors, locations sensors, and attention sensors, which relate to thegeneral condition of the subject or the environment relative to learningin general, but are not specific to the particular activity beinglearned.

Electroencephalographic (EEG) signal sensor 292 can be configured to fitwithin an ear canal of a subject, e.g., on an ear canal insert (forexample as described in U.S. Patent Publication 2003/0195588 to Fischellet al., or U.S. Patent Publication 2006/0094974 to Cain, both of whichare incorporated herein by reference). Physiological sensor 320 caninclude, for example, an electromyographic (EMG) sensor 298, a heartrate sensor (which may be used to heart rhythm variability, as well asheart rate, and may include, but is not limited to, and EKG orpulse-oximeter based heart rate sensor), an oxygenation sensor, bloodpressure sensor, perspiration sensor, skin conductivity sensor,respiration sensor, pupil dilation sensor, digestive tract activitysensor, or piloerection sensor. In another aspect, environmental sensor328 includes a light sensor, which may be configured to sense lightlevel and or day length. Environmental sensor 328 may include atemperature sensor 318, or an acoustic sensor (not shown), e.g.,configured to sense ambient noise level. Other types of sensors forproviding information regarding the state of the subject and his or herenvironment may be used, without limitation, including motion sensor 300or location sensor 322, for example. A variety of physiological andenvironmental sensors are described in U.S. Pat. No. 8,204,786 toLeBoueuf et al., which is incorporated herein by reference. Digestivetract activity may be sensed with external acoustical sensors, forexample as described in “New disposable biosensor may help physiciansdetermine which patients can safely be fed following surgery,”MedicalXpress, Aug. 7, 2014, which is incorporated herein by reference.

FIG. 3 depicts further aspects of system 200. Neural stimulator 202,prompting system 204, sensing system 206, electrical control circuitry208, stimulator control circuitry 240, prompter control circuitry 252,and timing control circuitry 256, are as described in connection withFIG. 2, as are any other components of FIG. 3 having the same referencenumbers as components of FIG. 3.

FIG. 3 provides detail regarding additional aspects of electricalcontrol circuitry 208. FIG. 3 also illustrates secondary stimulus source350 and performance feedback system 352, which are used in someembodiments.

Secondary stimulus source 350 is used to deliver a secondary stimulus354 to subject 214. In an aspect, secondary stimulus 354 assists subject214 in performing the task to be learned and/or enhances learning of thetask. Secondary stimulus source 350 may be, for example, a TENS unit356, a muscle stimulator 358, a nerve stimulator 360, a mechanicalassist device 362, a mechanical stimulator 364, a mechanical restraint366, a force applying element 368, an olfactory stimulus source 370, agustatory stimulus source 372, a nociceptive stimulus source 374, avibrator 376, haptic device 378, an auditory stimulus source 380, or athermal stimulator 381. In an aspect, secondary stimulus source 350includes a controllable compression garment 382. For example, in anaspect, a secondary stimulus source 350 (e.g. mechanical assist device362) assists subject 214 in performing a motor task. In another aspect,a secondary stimulus source 350 (e.g., mechanical restraint 366 or forceapplying element 368) provides resistance to movement as a subjectperforms a motor task, either to prevent incorrect movement or tonecessitate greater application of force as the subject performs adesired movement. In another aspect, a secondary stimulus source 350(e.g., mechanical stimulator 364, nociceptive stimulus source 374, orvibrator 376) delivers a stimulus to a portion of the subject's body toremind the subject to control movement of the specific portion of thebody. In an aspect, a secondary stimulus source 350 (e.g. an olfactorystimulus source 370, a gustatory stimulus source 372, an auditorystimulus source 380) provides a secondary stimulus 354 that promotesmulti-sensory learning. In an aspect, secondary stimulus source 350includes a component of prompting system 204 and/or performance feedbacksystem 352, which is described herein below. In another aspect, at leastone secondary stimulus source 350 is different from and/or distinct fromcomponents of prompting system 204 and performance feedback system 352.Secondary stimulus source 350 is controlled by stimulator controlcircuitry 240, with timing of delivery of secondary stimulus 354controlled by timing control circuitry 256.

A noted above, in an aspect, system 200 includes performance feedbacksystem 352, which is configured to provide feedback 382 to subject 214regarding performance of an activity by the subject. For example, invarious aspects, feedback delivered with performance feedback system 352may inform subject 214 that a desired performance has been obtained, orinform subject 214 of the need to modify or improve performance. Forexample, in various aspects, performance feedback system 352 includes atleast one visible signal source 384, e.g. a display 386, or light 388, asound source 390, e.g. a speaker 392, a vibrator 394, force applyingelement 396, electrical stimulator 398, a mechanical stimulator 400, orolfactory stimulus source 402. In other aspects, performance feedbacksystem 352 includes an ultrasonic stimulator 404. In some aspects, thecomponents (display, sound source, stimulators, etc.) used to deliverperformance feedback to the subject may be the same components used byprompting system 204. Alternatively, some or all of the components usedto deliver performance feedback to the subject may be different fromand/or distinct from those used to prompt the subject. Any of thedevices disclosed as being suitable for use a secondary stimulus source350, performance feedback system 352, or prompting system 204 can beused in any of the other of these systems, and the specific exampleslisted for each of these systems are not intended to be limiting.

Performance feedback system 352 provides feedback 382 under control ofperformance assessment module 412

Stimulator control circuitry 240 is configured to control delivery ofneural stimulus 210 to the subject is based at least in part on aperformance rating generated by performance assessment module 412, forexample, by delivering a stimulus 210 when a relatively higherperformance rating is obtained to reinforce learning of proper techniqueand not delivering a stimulus (or, alternatively, delivering a learningblocking stimulus) when a poor performance rating is obtained. Asdescribed in greater detail herein below in connection with severalexamples, various parameters may be measured to assess performance ofdifferent types of tasks.

Electrical control circuitry 208 includes performance assessment module412 which is configured to evaluate performance of the activity bysubject 214. Performance assessment module 412 is configured to compareat least one sensed parameter 414 indicative a task performance(detected by sensing system 206) with at least one target parameter 416corresponding to a target performance of the motor task. Stimulatorcontrol circuitry 240 is configured to drive delivery of neural stimulus210 responsive to an output of the performance assessment module 412based at least in part on a comparison of the at least one sensedparameter 414 with the at least one target parameter 416. For example,in an aspect the at least one target parameter 416 corresponds to apreferred task performance. As noted above, in some aspects sensingsystem 206 is adapted to sense a plurality of parameters indicative ofperformance of task by the subject; performance assessment module 412may then be configured to compare the plurality of parameters with aplurality of target parameters, and stimulator control circuitry 240configured to drive delivery of the neural stimulus responsive to anoutput of the performance assessment module 412 based at least in parton a comparison of the plurality of parameters with the plurality oftarget parameters.

In an aspect, system 200 includes a selection module 418 adapted tocompare parameters corresponding to two or more historical performancesof the task by the subject (historical data 420) and select at least oneparameter corresponding to at least one best performance of the two ormore historical performances, wherein the preferred task performance isthe at least one best performance. In an aspect, performance assessmentmodule 412 is configured to compare the at least one parameter 414 withat least one historical parameter corresponding to at least onehistorical performance of the task by the subject. In another aspect,selection module 418 is adapted to compare two or more portions of twoor more historical performances of the task by the subject, select thebest two or more portions of the two or more historical performances,and combine the best two or more portions to produce a best combinedhistorical performance.

In an aspect, electrical control circuitry 208 includes example module422, which is used to control delivery of an example of a task tosubject 214. The example may be provided via user interface device 436,or via various output and user interaction devices forming components ofprompting system 204, secondary stimulus source 350, and/or performancefeedback system 352. In an aspect, example module 422 is used forcontrolling delivery of an example of a sound pattern to the subject. Anexample of the sound pattern can be presented in graphical form, andtake the form of a musical score, a script, or a text presented viadisplay 386, for example. In another aspect, an example of a soundpattern can be presented in audio form, via one or more sound source390, for example. For example, an example of a piece of music thatsubject 214 is learning could be a recording of the piece of music,played by a skilled musician. An example of a motor task can be, forexample, a verbal description of the motor task, presented via soundsource 390, for example, or a video of the performance of the motortask, presented via display 386. In another aspect, example module 422controls delivery of an example of a motor task (e.g., a motor taskinvolving the subject moving their body in a specific pattern) tosubject 214 via one or more output devices that cause the subject's bodyto move in the specific pattern, e.g., muscle stimulator 358, nervestimulator 360, mechanical assist device 362, mechanical stimulator 364,or mechanical restraint 366. As is described in greater detail elsewhereherein, in some cases the example is provided to subject 214 prior todelivering a prompt for prompting the subject to perform the task. Inother cases the prompt is the same as the example. The example can takevarious forms, depending on the task being learned. Furthermore, asingle task can be represented by several different types of examples(e.g., a piece of music to be learned can be represented in an audiorecording or a musical score; moreover, playing a piece of music on aviolin, for example, requires learning a particular set of musclemovements needed to generate the desired sound).

In an aspect, system 200 includes communication circuitry 430 forproviding communication between electrical control circuitry 208 and acomputing or communication network 432. In addition, communicationcircuitry 430 provides for communication between separately packagedcomponents of system 200 located in the vicinity of subject 214, suchthat the components are operably connected. In some aspects,communication circuitry 430 provides for wired communication.Alternatively, or in addition, a wireless communication link may beprovided. In various aspects, a wireless communication link includes atleast one of a radio frequency, wireless network, cellular network,satellite, WiFi, BlueTooth, Wide Area Network, Local Area Network, orBody Area Network communication link. Communication between locationsremote from each other may take place over telecommunications networks,for example public or private Wide Area Network (WAN). In general,communication between remote locations is not considered to be suitablyhandled by technologies geared towards physically localized networks,e.g., Local Area Network (LAN) technologies operation at Layer 1/2 (suchas the forms of Ethernet or WiFi). However, it will be appreciated thatportions (but not the entirety) of communication networks used in remotecommunications may include technologies suitable for use in physicallylocalized network, such as Ethernet or WiFi.

In an aspect, system 200 includes at least one user interface device 436for at least one of providing an output to the subject and receiving aninput from the subject. In an aspect, at least one user interface device436 includes one or more component of personal computing device 250.User interface device 436 includes one or more output device, such as anLED or other light emitting element, an alphanumeric display, agraphical display, or other screen, audio output, or tactile display, orinput devices, e.g., a touchscreens, keyboard, mouse, button, dial, orvoice command input. In some aspects, a user interface device 436includes a brain computer interface.

In an aspect, system 200 includes scheduling module 438 for creating apractice session schedule, and generating reminders to remind subject214 of one or more practice sessions from the practice session schedule.Scheduling module 438 can interface with one or more calendars storedlocally or remotely, to add practice sessions to a calendar, retrievepractice session information from a calendar, and coordinate schedulingwith other events on the calendar, for example.

In an aspect, system 200 includes tracking module 440 configured totrack practice sessions during which the subject practices the activityand to store tracked practice session data in a data storage location,e.g. data storage location 244. For example, in an aspect, trackingmodule 440 is configured to track time and date of practice sessions. Inan aspect, tracking module 440 is configured to track duration ofpractice sessions. In an additional aspect, tracking module 440 isconfigured to generate practice session trends or metrics based on oneor more tracked practice sessions.

In an aspect, system 200 includes reporting circuitry 442 for reportinginformation regarding one or more tracked practice sessions, practicesession trends, or practice session metrics. For example, reportingcircuitry can be used to provide a report to one or more of the subject,a parent, an instructor, a coach, a medical care provider, or a peer. Insome aspects, a report is provided to other parties, for example, aninsurance company or a service provider (e.g., a business or otherentity that provides services related to system 200 or related tomonitoring use of system 200). In an aspect, a report is provided to atleast one social media contact (or ‘friend’), e.g., via a socialnetwork. In an aspect, reporting circuitry 442 causes a report to beprovided via user interface device 436 or via network 432 (accessed viacommunication circuitry 430), e.g. to a computing system used forstoring and/or processing healthcare or other information (e.g.,including a computing device, memory, network, record, or file). Invarious aspects, anonymization circuitry 444 is used to provide thereport in anonymized form (e.g., with information identifying thesubject removed therefrom). Reports provided by reporting circuitry 442may include various types of information, including but not limited toinformation regarding device and system settings, stimuli delivered(including neural stimulus and secondary stimulus) as well as practicesessions, practice session trends, or practice session metrics.Reporting and tracking functions may be generally as described in U.S.Published Patent Application No. 2016/0279435 to Hyde et al., which isincorporated herein by reference.

In an aspect, reporting circuitry 442 provides reports based on one ormore tracked practice sessions to a scoring module 446. For example, inan aspect, scoring module 446 assigns a score or ranking to subject 214based on the performance of the subject during the one or more trackedpractice sessions. In an aspect, scoring module 446 assigns a score orranking to subject 214 based on the subject's performance relative tothe performance of one or more other individuals.

In some aspects, the subject's attentiveness, e.g., to the task beingperformed, is assessed by attention tracking module 448, which itreceives as an input indicative of attentiveness of subject 214 fromsensing system 206 (e.g., from attention sensor 326 depicted in anddescribed in connection with FIG. 2). Attention tracking module 448 isoperatively connected to attention sensor 326, and determines whetherthe subject is attentive based on at least one parameter sensed byattention sensor 326. If it is determined with attention tracking module448 that subject 214 is not attentive, then a notification may begenerated with notification circuitry 450. For example, in variousaspects, notification circuitry 450 provides for delivery of an audioalarm tone, a verbal notification, a visible notification, a tactilenotification, an electronic notification stored in a data storagelocation (e.g., data storage location 244) or an electronic notificationtransmitted to at least one additional location, e.g. via network 432.In various aspects, notification circuitry 450 provides for delivery ofa notification via user interface device 436, one or more components ofprompting system 204 or performance feedback system 352, or other userinterface or output devices. The user interface or output device used incombination with notification circuitry 450 forms a notification system.In various aspects, the notification system is used to provide systemdiagnostic information, instructions, notification of fault or alarmconditions, etc.. In an aspect, notification circuitry 450 includescircuitry for delivering a voice message (e.g., a preset messageretrieved from data storage location 244). In a further aspect,notification circuitry 450 includes circuitry for storing information ina data storage location 244.

In an aspect, system 200 includes reward module 452 for transferring areward to the subject account based upon one or more tracked practicesession. In an aspect, reward module 452 is adapted to deliver a rewardto the subject, e.g. via user interface or output devices. In an aspect,reward module 452 is adapted to provide positive feedback to the subjectvia a user interface (for example, a verbal notification stating“Terrific! Keep up the good work!” or the like). In an aspect, rewardmodule 452 is adapted to deliver the reward to the subject based upon atleast one of attentiveness of the subject, as determined by attentiontracking module 448; performance of the subject, as determined byperformance assessment module 412; and system usage by the subject, asdetermined by tracking module 440. In another aspect, reward module 452is adapted to credit reward points to an account associated with thesubject. For example, reward points may be redeemable for money, aphysical reward item, game play, status points, etc. The user accountmay information may be stored locally (e.g., in data storage location244), or remotely, (e.g. at a location in network 432). In an aspectreward module 452 provides a competitive and/or gameplay element thatallows subject 214 to compete with their own previous performances, orwith the performances of others. In an aspect, reward module 452 creditsreward or status points for use in one or more other games not directlyrelated to the learning system described herein.

In an aspect, system 200 includes recommendation circuitry 454 forpresenting a recommendation to the subject. The recommendation may bepresented to the subject via user interface device 436 or via otheroutput devices forming components of prompting system 204 and/orperformance feedback system 352, for example. In an aspect, system 200receives the recommendation via a computing network, for example, from amedical care provider, from an insurance company, a service provider, anadvisor, a computation-based system (including, e.g., an artificialintelligence), or a social media source, for example. In variousaspects, recommendation circuitry 454 is configured to recognize asource of a recommendation and respond differently depending upon thesource of the recommendation. Recommendations from more credible sourcesmay be presented to the subject more promptly or more prominently,whereas recommendations from undesirable sources may be blocked, forexample. A recommendation may relate to a configuration of neuralstimulus or secondary stimulus. In other aspects, a recommendationrelates to one or more of a consumer product, a service, a userexperience, a user activity, or an organization that may be of interestto the subject, e.g., because the recommendations would enhance or becompatible with the effects of the neural stimulation received by thesubject, or in some other manner relate to training provided via system200. In an aspect, subject 214 can enter acceptance or rejection of arecommendation via user interface device 436.

In an aspect, system 200 includes patch/update module 456 for receivinga patch/update at system 200. For example, in an aspect, thepatch/update includes a software patch or update for software residingon personal computing device 250 and/or electrical control circuitry 208and may be received, for example, from the manufacturer of one or morecomponent of system 200, from a service provider, or the like. In anaspect, patch/update module 456 is configured to update theconfiguration of at least one of the neural stimulator 202 and/orelectrical control circuitry 208 based on historical data 420 (e.g., asstored in data storage location 244). In another aspect, patch/updatemodule 456 is configured to update the configuration based on andinstruction received via user interface device, or via network 432.

In another aspect, patch/update module 456 is configured to update theconfiguration of at least one of neural stimulator 202 and/or electricalcontrol circuitry 208 based on at least one recommendation received byrecommendation circuitry 454. In an aspect, input is received fromsubject 214 by user interface device 436 regarding acceptance orrejection of the recommendation, and patch/update module 456 updates theconfiguration responsive to acceptance of the recommendation by thesubject (if the recommendation is rejected, no update is made inresponse to the recommendation). In another aspect, patch/update module456 is configured to update the configuration of at least one of theneural stimulation device and the personal computing device based on anenvironmental parameter (e.g., sensed by an environmental sensor 328 insensing system 206, as shown in FIG. 2). In another aspect, patch/updatemodule 456 is configured to update the configuration of at least one ofthe neural stimulator and/or electrical control circuitry automatically.For example, in an aspect, the configuration is updated automaticallyaccording to a schedule.

In an aspect, communication circuitry 430 is configured to receiveinformation via a secure connection. The secure connection may beprovided through the use of an encrypted signal, for example. In anaspect, system 200 includes authentication circuitry 458 for receiving acredential showing that subject 214 is an authorized user. In an aspect,system 200 can be operated only following receipt of the credential. Invarious aspects, authentication circuitry 458 receives a password, apersonal identification number, a biometric feature, or a cardauthentication, for example.

FIG. 4 illustrates a generalized form of circuitry-based systems asdepicted in FIGS. 2 and 3 and elsewhere herein. Although specificembodiments are described herein, those skilled in the art willappreciate that methods and systems as described herein can beimplemented in various ways. Reference is made herein to variouscircuitry systems and subsystems (e.g., system 200 in FIGS. 2 and 3includes electrical control circuitry 208, which may be considered to becontrol/processing circuitry. As shown generically in FIG. 4, a system470 includes a circuitry-based system 472. Circuitry-based system 472,which in some aspects is a computing device or computing subsystem,includes control/processing circuitry 474, which includes any or all ofdigital and/or analog components 476, one or more processor 478 (e.g., amicroprocessor), and memory 480, which may store one or more programmodule 482 and/or data 484. In some aspects, control/processingcircuitry provides for preliminary handling of data from one or moresensor 486, transfer of data to remote device 496, receipt of controlsignal from remote device 496, and actuation of actuator 488, which maybe for example a neural stimulator (such as neural stimulator 202,prompting system 204, secondary stimulus source, and performancefeedback system 352 shown in FIGS. 2 and 3). Systems as described hereinmay receive signals from various sensors (e.g., sensing system 206depicted in FIGS. 2 and 3). System 470 may include other components asknown to those skilled in the art, e.g., one or more power supply 490,I/O structure 492, clock, timer, data bus, etc. I/O structure 492permits communication with various types of user interface devices(represented by user interface 494, which may include one or more inputdevices such as a keyboard, button, switch, computer mouse, ortouchscreen or one or more output devices such as screen, sound source,alphanumeric display, Braille display, etc.) and communication withvarious types of remote device 496, which may have control/processingcapability conferred by control/processing circuitry 498.

FIG. 5 is a flow diagram of a method 500 relating to enhancing learningthrough use of a system as depicted in FIG. 1. Here and elsewhere,method steps outlined with dashed lines represent steps that areincluded in some, but not all method aspects, and combinations of stepsother than those specifically depicted in the figures are possible aswould be known by those having ordinary skill in the relevant art.

Method 500 includes delivering, with a neural stimulator housed in ahousing fitted in or on at least a portion of an ear of a subject, atranscutaneous neural stimulus to a peripheral neural structure locatedat least in part in or on the ear of a subject, wherein the neuralstimulator is controlled by electrical control circuitry operablycoupled to the neural stimulator, at 502; delivering, with a promptingsystem under control of the electrical control circuitry, at least oneprompt to the subject for prompting the subject to repeatedly perform aspecific activity, wherein the electrical control circuitry is operablycoupled to the prompting system, at 504; controlling, with theelectrical control circuitry, a timing of delivery of the transcutaneousneural stimulus with respect to the at least one prompt and a number ofrepetitions of the specific activity that the subject is prompted toperform by the at least one prompt, at 506.

FIGS. 6-12 depict methods including additional and alternative stepsrelative to the method of FIG. 5. Steps 502-506 are as described inconnection with FIG. 5.

FIG. 6 depicts a method 600, wherein, in various aspects delivering thetranscutaneous neural stimulus includes one or more of delivering thetranscutaneous neural stimulus continuously during a stimulation period,at 602; delivering the transcutaneous neural stimulus intermittentlyduring a stimulation period, at 604; delivering a pulsed transcutaneousneural stimulus, at 606; delivering a transcutaneous neural stimulushaving a time-varying amplitude, at 608; delivering a transcutaneousneural stimulus having a time-varying frequency, at 610; or delivering atranscutaneous neural stimulus having a time-varying envelope, at 612.

FIG. 7 depicts a method 700, including controlling the timing ofdelivery of the transcutaneous neural stimulus with respect to the atleast one prompt (as indicated at 506) to deliver the transcutaneousneural stimulus prior to the at least one prompt, at 702; subsequent tothe at least one prompt, at 704; or overlapping at least partially intime with delivery of the at least one prompt, at 706. In an aspect,wherein controlling the number of repetitions of the specific activitythat the subject is prompted to perform includes controlling delivery ofone prompt for each of the number of repetitions, as indicated at 708.

In another aspect, controlling the number of repetitions of the specificactivity that the subject is prompted to perform includes controllingdelivery of a first prompt that informs the subject of the number ofrepetitions and a second prompt that is repeated once for each of thenumber of repetitions, as indicated at 710.

In yet another aspect, controlling the number of repetitions of thespecific activity that the subject is prompted to perform includescontrolling delivery of a first prompt that informs the subject of thespecific activity that is to be performed and a second prompt that isrepeated once for each of the number of repetitions, as indicated at712. In another aspect, controlling the number of repetitions of thespecific activity that the subject is prompted to perform includescontrolling delivery of the at least one prompt at a fixed rate for afixed period of time, as indicated at 714.

FIG. 8 depicts a method 800 detailing further aspects of delivering aprompt. In various aspects, delivering the at least one prompt includesdelivering an audible prompt 802; delivering a visible prompt 804;delivering an audio-visual prompt 806; delivering a tactile or hapticprompt 808; or delivering an electrical stimulus 810. In variousaspects, delivering the at least one prompt includes delivering the atleast one prompt via a speaker 812; a display 814; a personal computingdevice 816; or a wearable item 818. In some aspects, the promptingsystem is located at least in part in or on the housing, as indicated at820. In other aspects, delivering the at least one prompt includesdelivering the at least one prompt via a prompting system attached to ormounted in or on an instrument, implement, article of equipment, orarticle of clothing, as indicated at 822, or delivering the at least oneprompt via two or more of a display, a light, a speaker, a vibrator, anelectrical stimulator, and an olfactory stimulus source, as indicated at824.

FIG. 9 depicts a method 900 including steps 502-506 as depicted in FIG.5 and also including detecting performance of the activity by thesubject with a sensing system, as indicated at 902. In various aspects,detecting performance of the activity includes detecting performance ofa mental activity by the subject, at 904; detecting performance of aphysical activity by the subject, at 906; or detecting performance oftwo or more related physical or mental activities by the subject, at908.

In various aspects, detecting performance of the activity includesdetecting a signal with an EEG sensor, an EMG sensor, an oxygenationsensor, a motion sensor, a pressure sensor, a force sensor, anaccelerometer, an inclinometer, an implantable sensor, a wearablesensor, a sensor carried by the subject, a sensor in or on aninstrument, implement, or article of equipment carried by the subject, aremote camera, and a microphone, as indicated at 910.

Method 900 may also include providing feedback to the subject with afeedback system regarding performance of the activity by the subject, asindicated at 912. For example, in various aspects, providing feedback tothe subject includes providing feedback with at least one of a display,a light, a speaker, a vibrator, a force applying element, an electricalstimulator, or an olfactory stimulus source, as indicated at 914.

FIG. 10 depicts a method 1000, including further detail regardingdelivery of a transcutaneous neural stimulus. In various aspects, thetranscutaneous neural stimulus is a learning-enhancing stimulus, asindicated at 1002; or a memory-blocking stimulus, as indicated at 1004.In other aspects, delivering a transcutaneous neural stimulus, as at502, includes one or more of delivering the transcutaneous neuralstimulus to a cranial nerve of the subject, as indicated at 1006;delivering the transcutaneous neural stimulus to a vagal nerve of thesubject, as indicated at 1008; delivering the transcutaneous neuralstimulus to a trigeminal nerve of the subject, as indicated at 1010;delivering the transcutaneous neural stimulus to a glossopharyngealnerve of the subject, as indicated at 1012; delivering thetranscutaneous neural stimulus to a peripheral neural structureinnervating a pinna of the ear of the subject, as indicated at 1014;delivering the transcutaneous neural stimulus to a peripheral neuralstructure innervating an ear canal of the ear of the subject, asindicated at 1016; or delivering the transcutaneous neural stimulus to aperipheral neural structure innervating a concha of the ear of thesubject, as indicated at 1018.

FIG. 11 depicts additional method aspects. As indicated at 1102, in anaspect method 1100 includes delivering a secondary stimulus to thesubject with a secondary stimulus source. For example, in variousaspects, delivering the secondary stimulus to the subject includesdelivering a stimulus with at least one of a TENS unit, a musclestimulator, a nerve stimulator, a mechanical assist device, a mechanicalstimulator, a mechanical restraint, a thermal stimulator, a forceapplying element, an olfactory stimulus source, gustatory stimulussource, a nociceptive stimulus source, a vibrator, or an auditorystimulus source, as indicated at 1104.

In another aspect, method 1100 includes receiving, with an interfacedevice, a control input for setting stimulation parameters, as indicatedat 1106. In other aspects, method 1100 includes at least one of sendinga communication from the electrical control circuitry to a computing orcommunication network or receiving a communication at the electricalcontrol circuitry from the computing or communication network, viacommunication circuitry operably coupled to the electrical controlcircuitry, as indicated at 1108. In yet another aspect, method 1100includes at least one of providing an output to the subject andreceiving an input from the subject via a user interface device, asindicated at 1110.

FIG. 12 depicts a method 1200, including various aspects relating topractices sessions. In an aspect, method 1200 includes creating apractice session schedule, storing the practice session schedule in adata storage location operatively coupled to the electrical controlcircuitry, and generating reminders for delivery to the subject via theat least one user interface device operably coupled to the controlcircuitry to remind the subject of one or more practice sessions fromthe practice session schedule stored in the data storage location, asindicated at 1202.

In a further aspect, method 1200 includes tracking, with a trackingmodule, practice session data relating to at least one practice sessionduring which the subject practices the activity; and storing the trackedpractice session data in a data storage location, as indicated at 1204.For example, in an aspect, the practice session data includes a time anda date of at least one practice session, as indicated at 1206, or aduration of at least one practice session, as indicated at 1208. Inanother aspect, method 1200 includes generating practice session trendsor metrics based on one or more tracked practice sessions, as indicatedat 1210.

In an aspect, method 1200 includes reporting, with reporting circuitry,information regarding one or more tracked practice sessions, practicesession trends, or practice session metrics to one or more of thesubject, a parent, an instructor, a coach, a medical care provider, or apeer, as indicated at 1212. For example, in a related aspect, reportingwith the reporting circuitry includes providing reports based on thetracked practice session data to a scoring module, as indicated at 1214.Such a method may include assigning, with the scoring module, a score orranking to the subject based on the performance of the subject duringthe one or more tracked practice sessions, as indicated at 1216 and/orassigning, with the scoring module, a score or ranking to the subjectbased on the subject's performance relative to the performance of one ormore other individuals, as indicated at 1218. In a further aspect,method 1200 includes transferring, with a reward module, a reward to thesubject account based upon the tracked practice session data, asindicated at 1220.

FIG. 13 is a block diagram of a computer program product 1300 forimplementing a method as described in connection with FIG. 5. Computerprogram product 1300 includes at least one non-transitorycomputer-readable medium 1302 bearing one or more instructions forgenerating, under control of electrical control circuitry, at least onestimulus control signal for controlling delivery of a transcutaneousneural stimulus to a peripheral neural structure located at least inpart in or on an ear of a subject via a neural stimulator fitted in oron at least a portion of the ear of a subject; one or more instructionsfor delivering, via a prompting system under control of the electricalcontrol circuitry, at least one prompt for prompting the subject torepeatedly perform a specific activity; one or more instructions forcontrolling a timing of delivery of the transcutaneous neural stimuluswith respect to the at least one prompt; and one or more instructionsfor controlling a number of repetitions of the specific activity thatthe subject is prompted to perform by the at least one prompt, asindicated at 1304. A non-transitory computer-readable medium 1302 maybe, for example, a recordable medium 1306.

In addition, computer program product 1300 may include instructions forperforming various aspects of method steps outlined in FIGS. 6 to 12.For example, in various aspects, non-transitory computer-readable medium1302 bears one or more instructions for receiving, with an interfacedevice, a control input for setting stimulation parameters; one or moreinstructions for sending a communication from the electrical controlcircuitry to a computing or communication network, via communicationcircuitry operably coupled to the electrical control circuitry; one ormore instructions for receiving a communication at the electricalcontrol circuitry from a computing or communication network, viacommunication circuitry operably coupled to the electrical controlcircuitry; or one or more instructions for providing an output to thesubject and receiving an input from the subject via a user interfacedevice, e.g., for implementing a method as described in FIG. 11. Inother aspects, non-transitory computer-readable medium 1302 bearsinstructions relating to implementing methods as described in FIG.12.For example, in an aspect non-transitory computer-readable medium 1302bears one or more instructions for creating a practice session schedule;one or more instructions storing the practice session schedule in a datastorage location operatively coupled to the electrical controlcircuitry; and one or more instructions for generating reminders fordelivery to the subject via at least one user interface device operablycoupled to the control circuitry to remind the subject of one or morepractice sessions from the practice session schedule stored in the datastorage location. In another aspect, non-transitory computer-readablemedium 1302 bears one or more instructions for tracking, with a trackingmodule, practice session data relating to at least one practice sessionduring which the subject practices the activity; and one or moreinstructions for storing the tracked practice session data in a datastorage location. In an aspect, the one or more instructions for storingthe tracked practice session data in the data storage location includeone or more instructions for storing a time and a date of at least onepractice session, and/or one or more instructions for storing a durationof at least one practice session.

In an aspect, non-transitory computer-readable medium 1302 bears one ormore instructions for generating practice session trends or metricsbased on one or more tracked practice sessions.

In an aspect, non-transitory computer-readable medium 1302 bears one ormore instructions for reporting, with reporting circuitry, informationregarding one or more tracked practice sessions, practice sessiontrends, or practice session metrics to one or more of the subject, aparent, an instructor, a coach, a medical care provider, or a peer. Forexample, in an aspect, the one or more instructions for reporting withthe reporting circuitry include one or more instructions for providingreports based on the tracked practice session data to a scoring module.In connection therewith, non-transitory computer-readable medium 1302may bear one or more instructions for assigning, with the scoringmodule, a score or ranking to the subject based on the performance ofthe subject during the one or more tracked practice sessions, one ormore instructions for assigning, with the scoring module, a score orranking to the subject based on the subject's performance relative tothe performance of one or more other individuals, or one or moreinstructions for transferring, with a reward module, a reward to thesubject account based upon the tracked practice session data.

FIG. 14 depicts a system 1400 for enhancing learning to rehabilitatepatients with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) arises from exposure to one or moretraumatic, threatening events with a response of intense fear,helplessness, or horror. Symptoms may include: negative alterations incognition and mood (e.g., detachment or estrangement from others,negative emotions, negative expectations), and alterations in arousaland reactivity (e.g., hyper-vigilance, exaggerated startle response,sleep disturbances). A rehabilitative enhanced learning system tomodulate plasticity, alter mood, and improve cognition for PTSD patientsemploys cognitive training, timed neural stimulation and cognitionsensing. The system includes an earpiece 1402, a transcutaneous neuralstimulator 1404, an electrooculography (EOG) sensor 1406, electricalcontrol circuitry 1408, and personal computing device 1410, with videodisplay 1412 and video games provided by video game application 1414.

The learning system employs an earpiece 1402 connected to personalcomputing device 1410 (e.g., tablet computer or cell phone) to provideinstructions, feedback, and prompts to the patient in conjunction withdisplay of video games for cognitive training. Earpiece 1402 and videodisplay 1412 form a prompting system 1416. The video games reenact orreplay relevant traumatic events (e.g., combat, accidents, robberies,etc.) and prompt the patient to respond to the game with positiveactions in order to accrue points and complete the game. Timed neuralstimulation is applied in conjunction with playing of the video game,produced by video game application 1414 under control of electricalcontrol circuitry 1408. For example, transdermal stimulation of thetrigeminal nerve complex is accomplished with electrodes 1418, 1420, and1422 applied to the forehead, supraorbital region (temples) and cervicalregion, respectively (see e.g., Boasso, et al., bioRxiv preprintavailable online at: http://dx.doi.org/10.1101/043901, which isincorporated herein by reference. For example, stimulation withpulse-modulated (3-11 kHz), biphasic electrical current producingaverage amplitudes of 5-7 mA can be administered with a device targetingthe trigeminal nerve that is available from Thync Inc., Los Gatos,Calif. Cognitive training with the learning system is monitored usingelectrooculographic sensor 1406 to record eye movements by the patientwhile playing video games. For example, wearable sensors can recordchanges in electric potential field across the eye corresponding tomovements of the eye, including saccades, blinks and fixations (seee.g., Bulling et al., IEEE Transactions on Pattern Analysis and MachineIntelligence, 33, 741-753, 2011 and U.S. Patent Appl. 2015/0126845 byJin and Laszlo published on May 7, 2015 which are incorporated herein byreference). EOG recordings during visual task performance can provideinformation about an individual's attention, saliency, anxiety, effortand fatigue (see e.g., Bulling et al., Ibid. and Song et al.,International Journal Advanced Computer Science and Applications, 6,138-142, 2015 which are incorporated herein by reference).

Electrical control circuitry 1408, which is implemented in part onpersonal computing device 1410 and in part in circuitry componentsin/attached to headband 1424, includes stimulator control circuitry 1426(portions of which are located on headband 1424) adapted to generate atleast one stimulus control signal for controlling delivery of atranscutaneous neural stimulus to the cranial nerve with thetranscutaneous neural stimulator 1404; prompter control circuitry 1428adapted to generate at least one prompt control signal for controllingdelivery of the prompt by the prompting system formed by earpiece 1402and display 1412 of personal computing device 1410; and timing controlcircuitry 1430 for controlling a number of repetitions of the specificactivity that the subject is prompted to perform by the at least oneprompt and timing of delivery of the transcutaneous neural stimulus withrespect to the at least one prompt.

A subject (e.g. a military veteran) 1432 displays PTSD and is treatedwith enhanced learning system 1400 that provides timed neuralstimulation and cognitive training. The subject is provided withhardware for the enhanced learning system 1400 which includes personalcomputing device 1410 and headband 1424 including electrodes 1418 and1420, and electrooculography sensor 1406. Electrode 1422 is attached toheadband 1424 by a cable 1434, which allows it to be placed at adistance from the forehead on the back of the neck. Subject 1432 istrained to place earpiece 1402, headband 1424 (including electrodes 1418and 1420), and electrode 1422, to deliver electrical stimulation to thetrigeminal nerve complex in conjunction with a video game played onpersonal computing device 1410. The video game, produced by video gameapplication 1414, is selected to remind the patient of traumatic eventssuffered during military service, and learning system 1400 prompts thepatient to take positive action during the game in order to scorepoints. Learning system 1400 also includes eyeglass 1436 whichincorporates EOG sensors 1406 in the frames (see e.g., U.S. Patent Appl.2015/0126845, Ibid, which is incorporated herein by reference) tomonitor attention, anxiety and fatigue during game play. Based on EOGdata, timing control circuitry 1430 may cause stimulator controlcircuitry 1426 to initiate electrical stimulation of the trigeminalnerve complex at an optimal time and duration. EOG signals may alsoindicate that different parameters for neural stimulation are required.For example, lower frequencies (i.e. 0.5-0.7 kHz versus 3-11 kHz) may bemore efficacious (see e.g., Boasso et al., Ibid, which is incorporatedherein by reference). Based on EOG signals, control circuitry mayindicate another session of video gaming and neural stimulation isnecessary and prompter control circuitry instructs 1428 the patient torepeat the videogame or play another videogame. Alternatively, EOGsignals may indicate rest is required and prompter control circuitry1428 will inform the patient. Electrical control circuitry 1408 analyzesEOG data and performance in the video game to detect any changes incognitive behavior such as responsiveness, attention, anxiety, andfatigue. The schedule and protocol for using learning system 1400 may beadjusted to reflect any changes in cognition, and prompting system 1416prompts the patient, under control of prompter control circuitry 1428,to alter the protocol and schedule.

In the example of FIG. 14, EOG sensor 1406 is used as a neural sensor todetect neural activity. In other embodiments, other types of neuralsensors, for example, an EEG sensor, can be used to detect neuralactivity indicative of patient status. In some embodiments, the neuralsensor is housed with the transcutaneous neural stimulator. In variousembodiments, the transcutaneous neural stimulator can include a TENSunit or a patch electrode worn on the forehead, scalp, temple, face, orneck to deliver stimulation to a cranial nerve. In other embodiments,the transcutaneous neural stimulator can be worn on the ear of thepatient, taking the form of an earbud or other earpiece, to deliverstimuli to the ear canal, concha, or other portions of the ear, asdescribed in U.S. Published Patent Application No. 2016/0279435 to Hydeet al., which is incorporated herein by reference. A system as generallydepicted in FIG. 14 can be used to enhance learning of a mental task,cognitive task, memory or recall task. In various aspect, promptingsystem 1416 can be configured (e.g. by video game application 1414) todeliver the at least one prompt for prompting the subject to performaspects of various types of tasks, during the course of gameplay.

In some aspects, a transcutaneous neural stimulator includes at least afirst portion adapted to fit within a first region of an ear of thesubject (e.g., the ear canal) and a second portion adapted to fit withina second region of the ear of the subject (e.g., the concha) to deliverstimuli at different locations to access different nerves, or to providea bipolar electrode configuration. In some aspects, the system includestwo transcutaneous neural stimulators, one adapted to fit in or on afirst ear of the subject and the other adapted to fit in or on a secondear of the subject. Although the embodiment depicted in FIG. 14 isconfigured to deliver stimuli to a trigeminal nerve of the subject, inother embodiments, the transcutaneous neural stimulator can beconfigured to stimulate other cranial nerves (e.g., the vagal nerve orglossopharyngeal), via the ear canal or concha, for example.

FIG. 15 depicts a dance training system 1500 used to enhance learning ofmusic and dance movements. Training system 1500 uses video and audioprompts combined with neural stimulation to enhance learning ofchoreography and music. The system includes an earpiece 1502 thatcontains a speaker 1504 that conveys a sound output 1506 includingmusical and verbal cues to the dancer 1508. Earpiece 1502 also containsa transcutaneous neural stimulator (TNS) 1510 for delivering a neuralstimulus 1512 for enhancing learning to a cranial nerve. Visual promptsand other information are provided via video monitor 1514. Controlcircuitry 1516 is used to orchestrate and coordinate the neuralstimulation and audio and video signals. Video monitor 1514 displays avideo of example dance movements and visual representation of themusical score and timing cues. System 1500 includes movement sensors(e.g., accelerometers 1520, electromyographic sensors 1522) and a videocamera 1524, to monitor the dancer's performance, inform the controlcircuitry 1516 and provide feedback to the dancer 1508 via video monitor1514 and earpiece 1502.

The earpiece 1502 contains speaker 1504, a TNS 1510, control circuitry1516 and transceivers 1530 for wireless connection with a personalcomputing device 1538 and video monitor 1514. An earpiece 1502 with highfidelity speaker 1504 and wireless connectivity (e.g., via transceiver1530, which may be a Bluetooth or other RF transceiver) is incorporatedwith a TNS 1510 to provide electrical stimulation of the auricularbranch of the vagus nerve. For example, a transcutaneous stimulator thatis worn on the ear and stimulates the vagus nerve is available fromCerbomed, Erlangen, Germany. The training system earpiece 1502incorporates circuitry (e.g., transceiver 1530) to receive input frommovement sensors 1520 and 1522 worn by the dancer and from the videocamera 1524. Microprocessor 1536 and control circuitry 1516 in earpiece1502 process the movement data, evaluate dancer performance and controlthe timing, duration, and electrical parameters of neural stimulation.Also the number and duration of training sessions to learn the music andchoreography is recommended by control circuitry 1516. A personalcomputing device 1538, e.g., a laptop, stores example dance videos, theassociated music and music scores which are played coordinately withneural stimulation to promote neuronal plasticity and enhanced learningof motor skills and the associated music.

Dancer 1508 uses a dance training system 1500 to learn her part in amusical. Dancer 1508 activates the earpiece 1502, the laptop (1538) andvideo monitor 1514 and follows instructions from the earpiece 1502 andonscreen on video monitor 1514 to review the example video and music forthe dance she will perform. Following the example performance onscreen,dancer 1508 is prompted to perform the dance following the music audioand onscreen video which includes timing cues for the dance movements.The stimulator driver 1540 under control of control circuitry 1516provides neural stimulation timed to coincide with the dancer'sperformance. For example, vagus nerve stimulation with 0.8 mA, 100 μsecpulses at 30 Hz can be used to enhance motor skill training (see e.g.Dawson et al., Stroke 47, 143-150, 2016 which is incorporated herein byreference). Transcutaneous vagus nerve stimulation from an ear-mounteddevice may be done using a stimulus intensity of 0.5 mA, delivered witha pulse width of 200-300 μsec at 25 Hz and stimulation alternatedbetween on and off periods every 30 sec. See e.g., Sellaro et al.,Journal of Cognitive Neuroscience 27, 2126-2132, 2015 which isincorporated herein by reference. The control circuitry 1516 controlsthe timing and duration of the neural stimulation as well as thefrequency, current and pulse length.

The training system monitors the dancer's performance with movementsensors 1520 and 1522 and a video camera 1524 (video camera 1524 may bea discrete camera, as depicted in FIG. 15, or may be incorporated intolaptop 1538. Electromyographic (EMG) sensors 1522 are attached to thelegs to monitor muscle activation, while accelerometers 1520 areattached at wrists, waist and ankles to monitor movement and position oflimbs and torso. EMG data is transmitted wirelessly to the controlcircuitry 1516 via transceivers 1530), and processed to evaluate timingand movement during the dance (see e.g., Buchanan et al., J. AppliedBiomechanics 20: 367-395, 2004 which is incorporated by referenceherein). Video data of the dancer's performance from video camera 1524is processed and compared to the example performance by the systemcircuitry. The dancer's performance is evaluated and suggestedimprovements and additional training sessions are recommended. Controlcircuitry 1516 may also modify the neural stimulation parameters (e.g.,duration, current, timing) in response to the dancer's performanceevaluation. Finally, improved performance is rewarded with audio kudosand positive reinforcement from the training system (via earpiece 1502and video monitor 1514).

As described above, earpiece 1502 includes a speaker 1504 for deliveringsound output 1506 to the ear of the dancer. Sound output 1506 isgenerated by speaker 1504 in response to an audio signal 1542 producedby audio signal source 1544, which is a component of control circuitry1516. Alternatively, or in addition, audio signal 1542 generated byaudio signal source 1544 is transmitted by transceiver 1530, as wirelessaudio signal 1546, to speakers 1548 and 1550. In FIG. 15, speakers 1548and 1550 are depicted as being associated with video monitor 1514, butthey can instead be housed separately. In general, any sound sourceconnected (to audio signal source 1544 via either a wired or wirelessconnection can be used to produce a sound output responsive to audiosignal 1542.

Microprocessor 1536, in association with control circuitry 1516functions as a controller configured to control audio signal source 1544and stimulator driver 1540 to control timing of delivery of the soundoutput 1506 and the neural stimulus 1512. For example, controller can beconfigured (e.g., via a user input of personal computing device 1538) tocontrol audio signal source 1544 and stimulator driver 1540 to deliverthe learning enhancing stimulus after delivery of the sound output, todeliver the sound output after delivery of the learning enhancingstimulus, or deliver the sound output at least partially overlapping intime with delivery of the learning enhancing stimulus.

Stimulator driver 1540 operatively connected to transcutaneous neuralstimulator 1510 and configured to generate a stimulus control signal1548 adapted to drive delivery of the learning enhancing stimulus by theat least one cranial nerve stimulator; and a controller (microprocessor1536, control circuitry 1516) operatively connected to the audio signalsource (speaker 1504) and the stimulator driver 1540 and configured tocontrol at least one of generation of the audio signal 1542 the audiosignal source 1544 and generation of the stimulus control signal 1548 bythe stimulator driver 1540.

Video monitor 1514 is adapted to provide to the subject a visual promptcorresponding to a sound pattern. The sound pattern may be, for example,musical accompaniment for the dance being learned by dancer 1508.Display controller 1552 is configured to control presentation of thevisual prompt via the display, by generating a display control signal1554 which is transmitted as wireless video signal 1556 to video monitor1514. In the embodiment of FIG. 15, a visual representation of a dancechoreography corresponding to the sound pattern is depicted (e.g. avideo of a performance of the dance). The choreography presented onvideo monitor 1514 can represent parts for one or multiple dancer. Itwill be appreciated that various combinations of visual promptcorresponding to a sound pattern are possible. For example, dialog orsong lyrics corresponding could also be presented on the screen alongwith choreography (e.g. for use in musical theater productions). Forexample, in various aspects, display controller 1552 is configured tocontrol presentation via video monitor 1514 of a musical score includinga representation of the sound pattern, a script including textrepresenting the sound pattern. The display depicted in FIG. 15 is alarge screen display, but in other cases the display may be a screen ofa smart phone, a tablet computer, a laptop computer, a desktop computer,a television, or a wearable device. In various aspects, displays usedherein may also include projection displays (e.g., formed by using aprojector to project an image onto a screen or other surface) orflexible displays.

FIG. 16 depicts an embodiment of a training system 1600, used to enhancelearning of sound patterns by a subject 1602. In the example of FIG. 16,the system 1600 is used to assist subject 1602 in learning languagevocabulary, but the system could be used for learning other soundpatterns as well, as will be described in greater detail below. System1600 includes an audio signal source 1604 which is adapted to generatean audio signal 1606 for driving production by a sound source 1608 of asound output 1610 for delivery to the ear 1612 of the subject 1602.Sound output 1610 corresponds to a sound pattern to be learned bysubject 1602. System 1600 includes at least one earpiece 1620 adapted tobe carried by the ear 1612 of subject 1602, with at least one cranialnerve stimulator 1622 associated with earpiece 1620. Sound source 1608is a small speaker carried in or associated with earpiece 1620. Cranialnerve stimulator 1622 is adapted to deliver a learning enhancingstimulus 1624 to a cranial nerve of subject 1602 in association with thesound pattern. Learning enhancing stimulus 1624 is adapted to enhancelearning corresponding to the sound pattern by subject 1602. Stimulatordriver 1626 is operatively connected to cranial nerve stimulator 1622and configured to generate a stimulus control signal 1628 adapted todrive delivery of the learning enhancing stimulus 1624 by cranial nervestimulator 1622. System 1600 also includes controller 1630, which isoperatively connected to audio signal source 1604 and stimulator driver1626 and configured to control generation of audio signal 1606 by theaudio signal source 1604 and generation of stimulus control signal 1628by stimulator driver 1626.

Earpiece 1620 is configured as a headset, with a neural stimulatorconfigured to stimulate a cranial nerve of the subject for example asdescribed in U.S. Published Patent Application No. 2016/0279435 to Hydeet al., which is incorporated herein by reference. Controller 1630,audio signal source 1604, and stimulator driver 1626 are components of apersonal computing device 1632, here depicted as a table computer.However, although FIG. 16 depicts system 1600 implemented in connectionwith a table computer, in other embodiments some or all systemcomponents (e.g., audio signal source, stimulator driver, andcontroller) can be implemented on other devices, such as a smart phone,laptop computer, desktop computer, television, or wearable device.System 1600 delivers prompts, feedback, and other communications tosubject 1602 via display 1634 of personal computing device 1632, and viasound source 1608 (or, alternatively, or in addition, a sound sourcebuilt into or associated with personal computing device 1632).

Earpiece 1620 is depicted being connected to personal computing device1632 via a wired connection (cable 1636) in FIG. 16, but mayalternatively be connected via a wireless link, e.g., via Bluetoothconnection.

System 1600 also includes attention sensor 1638 which is an eye trackingsensor (implemented with a camera built into personal computing device1632) operatively connected to the controller 1630, which is used forsensing eye movement parameters indicative of attentiveness of thesubject.

An attention tracking module 1640 (as described generally in connectionwith FIG. 3) is operatively connected to the attention sensor 1638, andadapted to detect attentiveness of the subject based on the at least oneparameter indicative of attentiveness of the subject. The attentiontracking module is adapted to generate a notification if the subject isnot attentive. The notification includes an audio alarm tone deliveredvia earpiece 1620.

As noted above, prompts, feedback, and other communications aredelivered to subject 1602 via display 1634 of personal computing device1632, and via sound source 1608 (or, alternatively, or in addition, asound source built into or associated with personal computing device1632). Visual prompts corresponding to the sound pattern and deliveredvia display 1634 may include, for example, a script including textrepresenting a sound pattern. In the example of FIG. 16, a text prompt1642 includes a list of vocabulary words. In various aspects, the scriptincludes speech, a poem, a scripted dialog, a dramatic script, one ormore spelling words, one or more vocabulary words, one or more phrases,sentences, or paragraphs. The script can be for one or multiplespeakers.

An audio prompt is provided as sound output 1610 (in the example of FIG.16, an audio prompt of the words “uno, dos, tres.”

Attention sensor 1638 forms a component of a sensing system, while soundsource 1608 and display 1634 form components of a prompting system, asdescribed in connection with FIGS. 2 and 3. System 1600 includes variousother components, which are as depicted and described in connection withFIGS. 2, 3 and 4, and are not described in detail in connection withFIG. 16. For example, system 1600 can include a reporting circuitry,reward module as described in connection with FIG. 3.

In addition to the audio alarm noted above, system 1600 can beconfigured to deliver additional or alternative notifications, such as averbal notification, a visible notification, a tactile notification, oran electronic notification, which can be stored in a data storagelocation or transmitted to at least one additional location. Forexample, a notification transmitted to an additional location couldinclude a notification delivered to a parent, a teacher, a coach, amedical care provider, or other parties as appropriate to a particularlearning or training program that the subject is engaged in.Communication circuitry 1646 in system 1600 (e.g., a component ofpersonal computing device 1632) is adapted to provide communicationbetween controller 1630 and a computing or communication network 1648,and thus to one or more remote system 1650.

System 1600 includes sound sensor 1652 (e.g., a microphone) operativelyconnected to controller 1630 and adapted to sense a sound patternproduced by the subject. For example, after viewing one or more of textprompt 1642 on display 1634 or a sound output 1610 including an audioprompt delivered via sound source 1608, subject 1602 practices speakingthe vocabulary words. Performance assessment module 1654 is adapted toevaluate learning corresponding to the sound pattern by the subjectbased on the sensed sound pattern produced by the subject. In an aspect,performance assessment module 1654 includes a speech analyzer that canbe used to assess various aspects of the sound pattern produced by thesubject (e.g., speech) to evaluate learning. In general, the soundpattern produced by the subject can be assessed by comparing a parameterof the sound pattern to a target parameter. Parameters include, but arenot limited to, audio waveform, rhythm, tempo, pitch, intonation,emphasis, and pronunciation. In some aspects, the assessment moduleperforms speech recognition to identify words and assess word meaningand usage. In learning a foreign language, proper pronunciation is ofinterest. In the case that the subject is learning the spelling of aword, the subject may repeat the word and subsequently recite theletters spelling the word. In the case that the subject is learning themeaning of vocabulary words, the subject may repeat a phrase containinga definition of the word. For example, in an aspect, performanceassessment module 1654 is adapted to determine one or more word from thesensed sound pattern and compare it to a target word. In other aspects,comparisons are made between determined word meaning, grammar, wordorder, or letter order in comparison to a respective target. Performanceassessment module 1654 utilizes a performance rating system to assign atleast one performance rating to a performance of the audible task by thesubject.

System 1600 also includes a feedback system adapted to provide feedbackto the subject based upon the at least one performance rating (feedbackcan be provided in the form of a numerical score indicating percentmatch with target, a verbal assessment, which can be general (“goodjob,” “needs improvement”) or specific (“pronunciation is ‘A,’ not‘aye’”), which as described above in connection with FIGS. 2 and 3utilizes sound source 1608 and display 1634 to deliver feedback tosubject 1602. System 1600 includes reporting circuitry, which, asdescribed above in connection with FIG. 3, provides a report to one ormore of the subject, a parent, an instructor, a coach, a medical careprovider, or a peer based upon the at least one performance rating.

FIG. 17 is a flow diagram of a method 1700 for training a subject toperform a task corresponding to a sound pattern, which can be carriedout using systems as depicted in FIGS. 15 and 16, for example. Method1700 includes generating, with an audio signal source under control of acontroller, an audio signal for driving production of a sound output byan earpiece carried by an ear of a subject, the sound outputcorresponding to a sound pattern, wherein a task to be learned by thesubject corresponds to the sound pattern, at 1702; generating, with astimulator driver under control of the controller, a neural stimuluscontrol signal adapted to drive delivery of a neural stimulus with atleast one transcutaneous nerve stimulator associated with the at leastone earpiece and positioned on the ear of the subject to stimulate acranial nerve of the subject, the neural stimulus adapted to enhancelearning of the task by the subject, at 1704; delivering the neuralstimulus with the at least one transcutaneous nerve stimulatorresponsive to the stimulator driver, at 1706; delivering the soundoutput to the ear of the subject via the responsive to the audio signal,at 1708; and coordinating, with the controller, timing of delivery ofthe neural stimulus responsive to the stimulus control signal withrespect to timing of delivery of the sound output, at 1710.

FIGS. 18-23 depict further aspects relating to method 1700 shown in FIG.17, and steps 1702-1710 are as discussed in connection with FIG. 17.FIG. 18 illustrates method aspects relating to the sound output. In anaspect, method 1800 includes controlling the audio signal source and thestimulator driver with the controller to deliver the sound outputcorresponding to the sound pattern prior to delivery of the neuralstimulus, as indicated at 1802. In another aspect, method 1800 includescontrolling the audio signal source and the stimulator driver with thecontroller to deliver the sound output corresponding to the soundpattern subsequent to delivery of the neural stimulus, as indicated at1804. In another aspect, method 1800 includes controlling the audiosignal source and the stimulator driver with the controller to deliverthe sound output corresponding to the sound pattern at least partiallyoverlapping in time with delivery of the neural stimulus, as indicatedat 1806.

In various aspects, the sound output corresponding to the sound patternincludes the sound pattern, as indicated at 1808, or a musicalaccompaniment to the sound pattern, as indicated at 1810, (for example,in the case that the sound pattern is a musical part for a vocalist, orfor an instrumental soloist). To test the subject's memorization of hisor her part, the subject's part may be omitted from the prompt, and onlyparts played by others may be presented. For example, the sound patternis a portion of speech represented in a script, and the sound outputcorresponding to the sound pattern includes at least one portion of thescript not including the sound pattern, as indicated at 1812. Similarly,as another example, the sound pattern is a portion of music representedin a musical score, and the sound output corresponding to the soundpattern includes at least one portion of the musical score not includingthe sound pattern, as indicated at 1814.

FIG. 19 is a flow diagram of a method 1900, which includes presenting tothe subject, via a display under control of the controller, a visualprompt corresponding to the sound pattern, as indicated at 1902. In anaspect, presenting the visual prompt corresponding to the sound patternincludes presenting a musical score including a representation of thesound pattern, as indicated at 1904. For example, a score can be a vocalor instrumental score, and/or a score for an individual, an ensemble, ora soloist plus an accompaniment, without limitation.

In an aspect, presenting the visual prompt corresponding to the soundpattern includes a presenting a script including text representing thesound pattern via the display, as indicated at 1906. For example, invarious aspects, the script includes speech, a poem, a scripted dialog,a dramatic script, one or more letters, one or more words, one or morespelling words, one or more vocabulary words, one or more phrases,sentences, or paragraphs. The script can include any text to be learnedor memorized, e.g. foreign language vocabulary; numbers, equations,mathematical constant, or mathematical constructs; facts, theorems,theories, corollaries; and combinations of numbers, letter, and/or words(including lock combinations, passwords, etc.). The script can be forone or multiple speakers. It will be appreciated that the script maycontain one or both of a part being learned by the subject, and partsspoken by one or more others. To test the subject's memorization of hisor her part, the subject's part may be omitted from the prompt, and onlyparts spoken by others may be presented.

In yet another aspect, presenting the visual prompt corresponding to thesound pattern includes presenting via the display a visualrepresentation of a choreography corresponding to the sound pattern, asindicated at 1908. For example, in an aspect, presenting the visualprompt corresponding to the sound pattern includes presenting via thedisplay a video performance of choreographed movements corresponding tothe sound pattern, as indicated at 1910, as depicted in FIG. 15.

In another aspect, presenting the visual prompt corresponding to thesound pattern includes presenting a text or musical score including arepresentation of the sound pattern (for example, by various means asdescribed herein above), the method further comprising providing, viathe display under control of the controller, a visible indication of atarget temporal location within the text or musical score, as indicatedat 1912. FIG. 25 shows an example of a visible indication of a targettemporal location indicated within a musical score.

In yet another aspect, presenting the visual prompt corresponding to thesound pattern includes presenting a text or musical score including arepresentation of the sound pattern, the method further comprisingsensing, with at least one sound sensor operatively connected to thecontroller, a sound pattern corresponding to the sound pattern producedby the subject; determining, in real time, a current temporal locationin the sound pattern from the sound pattern; and providing, via thedisplay under control of the controller, a visible indication of thecurrent temporal location in the sound pattern within the text ormusical score, as indicated at 1914. In another aspect, presenting thevisual prompt includes presenting the visual prompt via a screen of asmart phone, tablet computer, laptop computer, desktop computer,television, or wearable device, as indicated at 1916.

FIG. 20 depicts a method 2000 illustrating various aspects relating todelivering the neural stimulus with the at least one transcutaneousnerve stimulator responsive to the stimulator driver at 1706. Forexample, in various aspects, the at least one cranial nerve stimulatoris a mechanical stimulator, as indicated at 2002; or an electricalstimulator, as indicated at 2004. In other aspects, delivering theneural stimulus includes delivering a magnetic stimulus, as indicated at2006; an electromagnetic stimulus, as indicated at 2008; a thermalstimulus, as indicated at 2010; an acoustic stimulus, as indicated at2012; or an ultrasonic stimulus, as indicated at 2014. In variousaspects, delivering the neural stimulus includes delivering the neuralstimulus to a vagal nerve of the subject, as indicated at 2016; or aglossopharyngeal nerve of the subject, as indicated at 2018. In otheraspects, delivering the neural stimulus includes delivering the neuralstimulus transcutaneously via an ear canal of the subject, as indicatedat 2020; a concha of the subject, as indicated at 2022; or a pinna ofthe subject, as indicated at 2024.

FIG. 21 depicts a method 2100 including sensing with at least oneattention sensor at least one parameter indicative of attentiveness ofthe subject, as indicated at 2102. In various aspects, sensing the atleast one parameter indicative of attentiveness of the subject includessensing an EEG, at 2104; eye movement, at 2106; an EMG, at 2108; amotion, as indicated at 2110; a force, as indicated at 2112; or anacceleration, as indicated at 2114.

In various aspects, sensing the at least one parameter indicative ofattentiveness of the subject includes sensing the at least one parameterwith a wearable sensor, at 2116 or a remote sensor, at 2118. Forexample, in an aspect, sensing the at least one parameter indicative ofattentiveness of the subject includes sensing at least one image with acamera, as indicated at 2120. In an aspect, sensing the at least oneparameter indicative of attentiveness of the subject includes sensing atleast one image with a user-facing camera of the smart phone, asindicated at 2122.

In another aspect, method 2100 includes tracking, with an attentiontracking module operatively connected to the attention sensor, whetherthe subject is attentive based on the at least one parameter, asindicated at 2124. In connection therewith, method 2100 includesdelivering a notification with a notification system if the subject isnot attentive, as indicated at 2126. For example, in various aspects,delivering the notification includes delivering one or more of an audioalarm tone, a verbal notification, a visible notification, a tactilenotification, or an electronic notification stored in a data storagelocation or an electronic notification transmitted to at least oneadditional location, as indicated at 2128.

FIG. 22 depicts a method 2200 illustrating other aspects relating todelivery of notifications, as well as providing reports and othercommunications. In an aspect, method 2200 includes delivering anotification to at least one of the subject and at least one additionalparty, as indicated at 2202. For example, in various aspects, deliveringthe notification includes generating at least one of an audio alarmtone, a verbal notification, a visible notification, a tactilenotification, or an electronic notification stored in a data storagelocation or an electronic notification transmitted to at least oneadditional location, as indicated at 2204.

In an aspect, method 2200 includes communicating information between thecontroller and a computing or communication network, as indicated at2206.

In an aspect, method 2200 includes providing, with reporting circuitry,a report to one or more of the subject, a parent, an instructor, acoach, a medical care provider, or a peer, as indicated at 2208. In anaspect, this includes delivering a reward to the subject with a rewardmodule, as indicated at 2210. In various aspects, delivering the rewardto the subject includes delivering the reward based upon at least one ofattention of the subject, performance of the subject, and amount ofusage by the subject, as indicated at 2212. In another aspect,delivering the reward to the subject includes crediting reward points toan account associated with the subject, as indicated at 2214. Forexample, in various aspects, reward points can be redeemable for money,a physical reward item, game play, games status, or other actual orvirtual rewards. In another aspect, delivering the reward to the subjectincludes delivering positive feedback to subject via a user interface,as indicated at 2216.

FIG. 23 depicts a method 2300, including sensing with at least one soundsensor a sound pattern produced by the subject, at 2302. In connectiontherewith, method 2300 includes evaluating learning corresponding to thesound pattern by the subject with a performance assessment module basedon the sensed sound pattern produced by the subject, as indicated at2304. In various aspects, evaluating learning corresponding to the soundpattern by the subject includes analyzing the sensed sound pattern witha speech analyzer, at 2306; determining one or more audio waveform fromthe sensed sound pattern and comparing it to a target audio waveform, at2308; determining one or more rhythm from the sensed sound pattern andcomparing it to a target rhythm, at 2310; determining one or more tempofrom the sensed sound pattern and comparing it to a target tempo, at2312; determining one or more pitch from the sensed sound pattern andcomparing it to a target pitch, at 2314; determining one or moreintonation from the sensed sound pattern and comparing it to a targetintonation, at 2316; determining one or more emphasis from the sensedsound pattern and comparing it to a target emphasis, at 2318;determining one or more pronunciation from the sensed sound pattern andcomparing it to a target pronunciation, at 2320; determining one or moreword from the sensed sound pattern and comparing it to a target word, at2322; determining one or more word meaning from the sensed sound patternand comparing it to a target word meaning, at 2324; determining one ormore grammar from the sensed sound pattern and comparing it to a targetgrammar, at 2326; determining one or more word order from the sensedsound pattern and comparing it to a target word order, at 2328; ordetermining one or more letter order from the sensed sound pattern andcomparing it to a target letter order, at 2330.

In an aspect, method 2300 includes assigning at least one performancerating based on an output of the performance assessment module, at 2332.In an aspect, method 2300 includes delivering, with a feedback system,feedback to at least one of the subject and another party based upon theat least one performance rating, as indicated at 2334. In an aspect,method 2300 includes delivering the neural stimulus to the subject basedat least in part on the at least one performance rating, as indicated at2336. In an aspect, method 2300 includes delivering a stimulus thatblocks learning by the subject based at least in part on the at leastone performance rating, as indicated at 2338.

FIG. 24 depicts a computer program product 2400 for implementing amethod as described in connection with FIG. 17. Computer program product2400 includes at least one non-transitory computer-readable medium 2402,bearing one or more instructions for generating, with an audio signalsource under control of a controller, an audio signal for drivingproduction of a sound output by an earpiece carried by an ear of asubject, the sound output corresponding to a sound pattern, wherein atask to be learned by the subject corresponds to the sound pattern; oneor more instructions for generating, with a stimulator driver undercontrol of the controller, a neural stimulus control signal adapted todrive delivery of a neural stimulus with at least one transcutaneousnerve stimulator associated with the at least one earpiece andpositioned on the ear of the subject to stimulate a cranial nerve of thesubject, the neural stimulus adapted to enhance learning of the task bythe subject; and one or more instructions for coordinating, with thecontroller, timing of delivery of the neural stimulus responsive to thestimulus control signal with respect to timing of delivery of the soundoutput, as indicated at 2404. Non-transitory computer-readable medium2402 may be, for example, a recordable medium 2406.

Computer program product 2400 may include instructions for performingvarious aspects of method steps outlined in FIGS. 18-23. For example, inan aspect non-transitory computer-readable medium 2402 bearsinstructions relating to method aspects shown in FIG. 18, including oneor more instructions for presenting a visual prompt corresponding to thesound pattern, the visual pattern including a text or musical scoreincluding a representation of the sound pattern; one or moreinstructions for sensing, with at least one sound sensor operativelyconnected to the controller, a sound pattern corresponding to the soundpattern produced by the subject; one or more instructions fordetermining, in real time, a current temporal location in the soundpattern from the sound pattern; and one or more instructions forproviding, via the display under control of the controller, a visibleindication of the current temporal location in the sound pattern withinthe text or musical score.

FIG. 25 depicts a learning system 2500 which is used for enhancinglearning of a sound pattern by a subject 2502. In the example of FIG.25, subject 2502 is a singer who uses learning system 2500 to learn amusical piece and improve his vocal performance. The learning system2500 includes an earbud device 2504 which delivers a sound output 2506and neural stimulus 2508 to subject 2502 during training sessions. Thesystem includes a personal computing device 2510 with a video display2512, microphone 2514, processor 2516, memory 2518 and software 2520 tocoordinate audiovisual instruction, prompting, neural stimulation,performance evaluation and feedback to the singer.

Learning system 2500 includes a neural stimulator 2522 located in earbuddevice 2504. Neural stimulator 2522 is used for delivering a neuralstimulus 2508 adapted to enhance learning of a sound pattern by subject2502. Learning system 2500 includes stimulator driver 2524, whichadapted to drive delivery of neural stimulus 2508 by neural stimulator2522. In addition, learning system 2500 includes sound source 2530 whichis adapted to provide a sound output 2506 to the subject, audio signalsource 2532 which is adapted to drive delivery of sound output 2506 bysound source 2530. Software 2520 includes example module 2534 forcontrolling delivery of an example 2536 of the sound pattern to subjectvia at least one of sound source 2530 and video display 2512, andprompting module 2540 for driving delivery of prompt 2542 via at leastone of sound source 2530, video display 2512, or an additional outputdevice 2544, in association with delivery of neural stimulus 2508 byneural stimulator 2522. Aside from a primary main visual prompt providedvia video display 2512, system 2500 can be programmed to deliveradditional or supplemental prompts from an additional output device. Forexample, various audible prompts (e.g. tones, verbal instructions, etc.)can be delivered via sound source 2530 or another sound source undercontrol of controller 2556. A flashing light or other visuallydetectable prompt can be provided via a controllable light source,controllable light-reflective device, or controllable color-changingdevice on or controlled by personal computing device 2510. Additionaloutput device 2544 can include a tactile or haptic stimulus source(e.g., a small vibrator on earbud device 2504) controlled by personalcomputing device 2510 that delivers a non-audible stimulus.

Earbud device 2504 contains miniature speakers which function as soundsource 2530 to provide audio instruction, prompts and musical examplesto the subject 2502. Earbud 2504 (and an earbud on the other ear, notshown) also contain neural stimulator 2522 which is a transcutaneousneural stimulator (TNS) to stimulate the vagus nerve in conjunction withperformance of the musical piece. For example, wearable ultrasounddevices (see e.g., Lewis Jr. et al., Ultrasound in Med. and Biol. 39:1429-1439, 2013) may be incorporated in the earbuds that rest inside thetragus of the ear to provide stimulation to the auricular branch of thevagus nerve (see e.g., U.S. Pat. No. 7,797,042 issued to Dietrich et al.on Sept. 14, 2010 which is incorporated herein by reference). Theultrasound device is empowered and controlled remotely by personalcomputing device 2510 via wireless transmission at radio frequency (RF)wavelengths. Earbud device 2504 includes microcircuitry 2550 and RFtransceivers 2552 to receive and transmit RF signals. The personalcomputing device 2510 includes video display 2512, audio signal source2532, RF transceiver 2554, memory 2518, processor 2516, controller 2556and software 1520 to provide: instructions, example musicalperformances, musical cues and accompaniment, and to coordinate timingand control of neural stimulation with musical performance. The computersystem is programmed to control the extent and timing of neuralstimulation based on performance evaluation and comparison to previousperformances. Personal computing device 2510 is also programmed toevaluate musical performances, suggest improvements, and to providefeedback to the student as well as to a teacher or mentor.

Subject 2502 begins a training session with learning system 2500 byprogramming the personal computer to train for a musical piece (e.g.,the Faure Requiem). The learning system software 2520 includes aninstructional audiovisual on the training system protocol, an exampleaudio performance of the Requiem, a video of the musical score andlyrics; cues for singing the musical piece, and an audio of musicalaccompaniment for singing the Requiem. Subject 2502 dons earbud device2504 placing the earbuds in each ear canal and initiates the learningsystem program on personal computing device 2510. An instructional videodelivered via video display 2512 and sound source 2530 in earbud device2504 describes the training protocol:

-   -   1) Listen to the example performance (an audio example delivered        via sound source 2530) and watch the video of musical score and        lyrics (a visual example 2560 delivered via video display 2512)        and mentally rehearse the performance. Neural stimulation, i.e.,        ultrasound stimulation from the earbud device starts and ends        simultaneously with the example performance.    -   2) Sing in response to audiovisual prompts (audio of        accompaniment music delivered via sound source 2530; video of        musical score and lyrics delivered via video display 2512);        ultrasound neural stimulation occurs simultaneous to the        student's performance.    -   3) Performance evaluation by the learning system algorithms is        applied to the audio recording and includes comparison to the        example performance and any previous student performances.        Performance parameters may include: pitch, timing/tempo,        intonation, and lyric memorization and pronunciation.    -   4) Feedback is provided to the singer critiquing the performance        and providing suggested improvements.

Following the instructional video the singer's initial performance isprompted by the audiovisual system and recorded via the microphone inthe personal computer. The singer is guided by the video of the lyricsand the musical score, and the timing of the lyrics and musicalaccompaniment is indicated on the video display. The singer'sperformance is evaluated by the system with respect to pitch,timing/tempo, intonation, and lyric memorization and pronunciation ascompared to the example performance. Feedback to the singer includescorrective actions to improve the performance, and preparation for asecond performance.

A second performance is prompted by the audiovisual system (see step 2in protocol above) and ultrasound stimulation from the earbuds isinitiated immediately following the prompt. Upon completion of the songneurostimulation is stopped and the learning system evaluates theperformance and compares it to the example performance and the initialperformance. If the current performance meets minimum standards ofperformance (e.g., correct pitch, sufficient range, intonation, timing,tempo, pronunciation, lyrics) then the system will provide neuralstimulation with the next performance. Feedback to the singer willinclude areas for improvement, strong points of the performance, andinstructions for the next performance.

The third performance is prompted as above (see step 2) and the systemwill initiate neural stimulation, i.e., ultrasound stimulation of thevagus nerve, simultaneous with the start of the singing performance.Ultrasound stimulation is sustained for the duration of the performance,and afterwards the third performance is evaluated and feedback isprovided to the student in preparation for a fourth performance.

A training session may include multiple performances, e.g., five ormore, with each performance evaluated and the feedback adjusted asneeded to improve the performance. Neural stimulation is provided if animproved performance is detected or a minimum level of performance isattained compared to the example performance. Neural stimulation may becontingent on improved scores from performance to performance. Theenhanced learning system may also provide a reward at the end of thetraining session in the form of positive feedback, credits forcoursework, or points in a self-directed training system. Competitiveperformances between two students may be orchestrated and evaluated bythe system.

Example module 2534 is adapted to control delivery of an audible exampleof the sound pattern to subject 2502 via at least one sound source 2530,and is also adapted to control delivery of a visual representation ofthe sound pattern to the subject via display 2512, i.e., example module2534 is adapted to control presentation of musical score 2560 on display2512. In addition, example module 1524 is adapted to controlpresentation of a text (e.g., lyrics 2562) on display 2512. It will beappreciated that in other uses of the training system, the text mayinclude one or more of a script, a speech, song lyrics, one or moreword, one or more paragraph, one or more phrase, one or more spellingwords, or one or more vocabulary words. In addition, example module isadapted to cause the display of one or more marker 2564 in the visualrepresentation indicating a time-varying location within the visualrepresentation. As depicted in FIG. 25, the marker is a dashed circlearound the note that subject 2502 should be singing. It will beappreciated that the current location in the score (or script, or othervisual representation) can be indicated by various means under controlof software 2520, e.g. with an arrow rather than a circle as depicted inFIG. 25, or by highlighting the note or text with a larger, brighter orotherwise distinctive font, with a different color or brightness, etc.in order to indicate the location within the score. As depicted in FIG.25, the “current location” is a target temporal location representingthe portion of the score that the subject should be performing at aparticular time; it also indicates a target note (pitch) to be producedby the subject. Although not depicted in FIG. 25, it would also bepossible to depict the actual current location of the subject inaddition to the target current location. In the event that subject 2502was singing off key or too slowly, the depiction of the actual currentlocation would help the subject to recognize the need to correct pitchor timing.

In an alternative embodiment of the system shown in FIG. 25, the soundsource (e.g., a speaker) and neural stimulator could be mounted in aheadphone rather than an earbud.

As described elsewhere herein, in various aspects prompting module 2540can be configured to drive delivery of the prompt at a set intervalprior to delivery of the neural stimulus, a set interval subsequent todelivery of the neural stimulus, or at a time overlapping at least inpart with delivery of the neural stimulus. Memory 2518 in learningsystem 2500 serves as a data storage location containing one or moredata structure for storing data representing the example of the soundpattern, information relating to at least one of the example, theprompt, and the neural stimulus, etc.. In an aspect, example module 2534is adapted to retrieve an example of the sound pattern from the datastorage location. In some cases, communication circuitry 2566 inpersonal computing device 2510 can receive data representing the exampleof the sound pattern from a remote location via a communication orcomputing network, e.g. as described in connection with U.S. PublishedPatent Application No. 2016/0279435 to Hyde et al., which isincorporated herein by reference. Communication circuitry 2566 can alsobe used for transmitting information relating to at least one of theexamples, the prompt, and the neural stimulus to a remote location via acommunication or computing network. Information relating to at least oneof the example, the prompt, and the neural stimulus can be received fromthe subject via a user interface associated with personal computingdevice 2510 (e.g., a keyboard, a mouse, a touchscreen).

FIG. 26 is a flow diagram of enhancing learning of a sound pattern by asubject. Method 2600 includes providing an example of the sound patternto the subject with a first output device under control of controller,at 2602; delivering a prompt, via a second output device controlled bythe controller, for prompting the subject to mentally rehearse the soundpattern, at 2604; and delivering a neural stimulus to the subject inassociation with the prompt, wherein the neural stimulus is deliveredwith a neural stimulator controlled by the controller and is adapted toenhance learning of the sound pattern by the subject, at 2606.

FIG. 27 shows a method 2700 including further aspects relating toproviding an example of the sound pattern to the subject with a firstoutput device under control of controller, at 2602.

In an aspect, providing the example includes providing a visualrepresentation of the sound pattern to the subject, at 2702. Forexample, the visual representation can include one or more of a musicalscore, as indicated at 2704, or a text, as indicated at 2706. In variousaspects, the text includes one or more of a script, a speech, songlyrics, one or more word, one or more paragraph, one or more phrase, oneor more spelling words, or one or more vocabulary words, as indicated at2708. In an aspect, method 2700 also includes providing one or moremarker in the visual representation indicating a time-varying locationwithin the visual representation, as indicated at 2710.

In an aspect, providing the example includes providing an audibleexample of the sound pattern to the subject, at 2712. For example,providing the audible example includes delivering the audible example tothe subject via an earbud, at 2714. In an aspect, delivering the neuralstimulus includes delivering the neural stimulus via a transcutaneousneural stimulator associated with the earbud and adapted to deliver atranscutaneous neural stimulus via at least a portion of an ear of thesubject, as indicated at 2716. In an aspect, providing the audibleexample includes delivering the audible example via a headphone, asindicated at 2718. In connection therewith, in an aspect delivering theneural stimulus includes delivering the neural stimulus via atranscutaneous neural stimulator mounted on the headphone, as indicatedat 2720.

FIG. 28 depicts a method 2800 illustrating various aspects relating todelivering a prompt, via a second output device controlled by thecontroller, for prompting the subject to mentally rehearse the soundpattern, at 2604. In an aspect, delivering the prompt includes providingan audible prompt, at 2802, which may include, for example, a tone, asindicated at 2804, or a verbal instruction, as indicated at 2806. In anaspect, the first output device and the second output device are thesame device, as indicated at 2808. In an aspect, the example is theaudible prompt, as indicated at 2810. In other aspects, delivering theprompt includes providing a visible prompt, as indicated at 2812, orproviding a tactile or haptic prompt, as indicated at 2814.

FIG. 29 depicts a method 2900 illustrating variants of delivering aneural stimulus to the subject in association with the prompt, whereinthe neural stimulus is delivered with a neural stimulator controlled bythe controller and is adapted to enhance learning of the sound patternby the subject at 2606. For example, in various aspects, delivering theneural stimulus includes one or more of delivering a stimulus to aperipheral neural structure of the subject, at 2902; delivering astimulus to a cranial nerve of the subject, at 2904; or delivering astimulus to a brain of the subject, at 2906. In an aspect, deliveringthe neural stimulus includes delivering the neural stimulus via animplanted stimulator, at 2908.

In various aspects, delivering the neural stimulus in association withthe prompt includes delivering the neural stimulus at a set intervalprior to delivering the prompt, as indicated at 2910; delivering theneural stimulus at a set time subsequent to delivering the prompt, asindicated at 2912; or delivering the neural stimulus at a timeoverlapping at least in part with delivery of the prompt, as indicatedat 2914.

FIG. 30 depicts a method 3000 depicting other method aspects. Forexample, in an aspect, method 3000 includes retrieving data representingthe example of the sound pattern from a data storage location associatedwith the controller, as indicated at 3002. In another aspect, method3000 includes receiving data representing the example of the soundpattern from a remote location via a communication or computing network,as indicated at 3004. In various other aspects, method 3000 includes oneor more of storing information relating to at least one of the example,the prompt, and the neural stimulus in a data storage locationassociated with the controller, as indicated at 3006; transmittinginformation relating to at least one of the example, the prompt, and theneural stimulus to a remote location via a communication or computingnetwork, as indicated at 3008; and including receiving informationrelating to at least one of the example, the prompt, and the neuralstimulus from the subject via a user input device, as indicated at 3010.

FIG. 31 depicts a computer program product 3100, including at least onenon-transitory computer-readable medium 3102 bearing one or moreinstructions relating to a method a shown in FIG. 26. Non-transitorycomputer-readable medium 3102 bears one or more instructions forproviding an example of the sound pattern to the subject with a firstoutput device under control of controller; one or more instructions fordelivering a prompt, via a second output device controlled by thecontroller, for prompting the subject to mentally rehearse the soundpattern; and one or more instructions for delivering a neural stimulusto the subj ect in association with the prompt, wherein the neuralstimulus is delivered with a neural stimulator controlled by thecontroller and is adapted to enhance learning of the sound pattern bythe subject, as indicated at 3104. In an aspect, non-transitorycomputer-readable medium 3102 is a recordable medium 3106, for example.

FIG. 32 illustrates a system 3200 for enhancing learning of a motor taskby a subject 3202. In the example of FIG. 32, the task learned bysubject 3202 is a proper swing of a golf club. System 3200 includes atranscutaneous neural stimulator 3204 (in the form of an earbud device3205) to deliver audible swing instructions in conjunction withtranscutaneous stimulation of the vagus nerve to enhance learning.Although a single earbud is depicted in FIG. 32, it will be appreciatedthat the system typically includes a pair of earbuds such that audibleinstructions and transcutaneous stimulation can be delivered to bothears. System 3200 includes a stimulator driver 3206 used in combinationwith personal computing device 3208, a sound source 3210, and sensingsystem 3212. Transcutaneous neural stimulator 3204 is used fordelivering a neural stimulus 3214 adapted to enhance learning of a motortask by subject 3202. Stimulator driver 3206 is adapted to drivedelivery of neural stimulus 3214 by transcutaneous neural stimulator3204. Sensing system 3212 is used for sensing at least one parameterindicative of performance of the motor task by subject 3202. Personalcomputing device 3208 includes controller 3220, processor 3222, display3224, data storage location 3226, and audio signal source 3228, which isadapted to drive delivery of a sound output 3230 by sound source 3210.System 3200 includes microcircuitry and software to provide visualinstruction, and feedback on performance, and to coordinate timing ofswing prompts and nerve stimulation. In particular, example module 3232is used for controlling delivery of an example 3234 of the motor task tosubject 3202 via sound source 3210, display 3224, and one or moreadditional output device, here illustrated as display 3236. In addition,prompting module 3238 is used for driving delivery of a prompt 3240 viasound source 3210, display 3224, or an additional output device (such asspeaker 3242 associated with display 3236), in association with deliveryof neural stimulus 3214 by neural stimulator 3204, for prompting subject3202 to perform the motor task. System 3200 also includes performanceassessment module 3244 for processing the at least one parameter sensedby sensing system 3212.

In the example of FIG. 32, transcutaneous neural stimulator 3204 is apiezoelectric speaker (e.g., piezoelectric speakers are available fromDigi-Key Corporation, Thief River Falls, MN 56701 USA) controlled bystimulator driver 3206 under control of controller 3220. Transcutaneousneural stimulator 3204 is located within the earbuds such that it can bepositioned inside the tragus of the ear to provide stimulation to theauricular branch of the vagus nerve (see e.g., U.S. Pat. No. 7,797,042issued to Dietrich et al. on Sept. 14, 2010 which is incorporated hereinby reference). Sensing system 3212 includes remote cameras 3250, 3252which provide feedback to system 3200, which analyzes the student'sperformance of the swing and the flight of the ball using performanceassessment module 3242. Sensing system 3212 also includes accelerometer3256 attached to the head of golf club 3258 to measure swing parameters.Sensing system 3212 also includes electromyographic (EMG) sensors 3260and 3262 which are attached at either hip of subject 3202, contactingthe skin, to monitor hip rotation and initiation of the downswing. EMGrecording is timed to follow the swing prompts and EMG data istransmitted wirelessly to the learning system processors and processedto evaluate timing and movement during swing performance (see e.g.,Buchanan et al., J. Applied Biomechanics 20: 367-395, 2004 which isincorporated by reference herein). Swing performance is evaluated bycomparison of swing data to ideal swing parameters stored in datastorage location 3226 and by analysis of golf ball flight path. Systemincludes personal computing device 3208 (here, the subject's cell phone)to provide network access and inductive power to the earbud device.System 3200 orchestrates training sessions composed of multiple swingsets with instruction, feedback, cues and prompts. Stimulation of thevagus nerve is coordinately timed with the swing prompts to enhancelearning of the evolving swing as the training session proceeds.

Subject 3202 begins a training session at a practice tee with thelearning system earbuds 3205 inserted in his ear canals and with remotevideo cameras 3250 and 3252 directed at the practice tee from the rearand side. Accelerometer 3256 is attached to the head of golf club 3258,and system 3200 plays an introductory video which provides instructions,including a preview of the training session format, prompting, andfeedback format and an example swing video, on display 3236(alternatively, or in addition, the training video may be presented ondisplay 3224 of personal computing device 3208). Example swing videoprovides example 3234, an illustration (in the form of a stick figureanimation) of a good golf swing. The introductory video describes theaudible prompts and replicate swing sets that will follow. Audibleprompts are delivered by via sound source 3210 in earbud device 3205, oralternatively/in addition, via an additional output device, speaker 2340associated with display 3236. For example, the swing elements aredemonstrated, and a swing set of 5 replicate swings with an audibleprompt for each swing is described. An example swing video is displayedand neural stimulation is initiated immediately afterward. Then, whenprompted, the student takes a swing at a golf ball and repeats theprocedure for 4 additional swings. After the first swing set, theenhanced learning system analyzes the swing performance data from thevideo cameras, the accelerometer and EMG sensors by comparison to idealswing data for a golfer of similar height, weight and skill level (e.g.,recreational). The system provides feedback to the student in an updatedinstructional video. For example, the feedback may emphasize the speedof the backswing (the student's backswing may be too fast) or the planeof the downswing (too steep or too shallow) and provide correctiveactions. The system then prompts the student to hit a second swing set,comprised of 5 replicate swings. The second swing set may be accompaniedby transcutaneous neural stimulation from the piezoelectric speakerslocated in the earbuds. However, neural stimulation may be contingent onswing performance. For example, if swing performance is below thresholdlevels relative to the example swing data then neural stimulation may bewithheld until improved performance is detected. Data from the secondswing set is compared to the example swing parameters stored in memoryand also to the previous swing set. An updated video provides feedbackand instructions to the student on their recent swing performance,including any corrective actions to be taken in the next swing set, forexample, slowing the backswing, starting hip rotation earlier, orreadjusting the backswing plane. A third swing set, consisting of 5swings is prompted by the learning system and accompanied by neuralstimulation from the piezoelectric speakers if swing performance hasimproved.

The swing data for the training session is analyzed by performanceassessment module 3242 in system 3200, and feedback is provided to thestudent as an instructional video which critiques the swing performanceand reinforces progress in achieving improved swing parameters (e.g.,swing velocity). Additional swing sets may be taught by the learningsystem to further improve the student's swing performance withrepetition and neural stimulation. A final video at the end of thetraining session reports progress in improving swing performanceparameters. The system may send the feedback videos and the trainingsession video to an instructor and the student, via mobile networkaccess by personal computing device 3208. Swing data is stored on anetwork computer, locally or remotely, and may be recalled for reviewprior to another training session or to establish the swing parametersand focus areas for a new training session. The learning system mayreward the student with an audio message or a favorite song when anincreased number of swing parameters are performed at a particular skilllevel, e.g., recreational golfer.

Although in the example shown in FIG. 32, system 3200 is used fortraining subject 3202 in a golf swing, such a system may be used fortraining a subject to perform various types of motor tasks, which may berelated to sports, recreational activities, job-related activities,performing arts, or activities of daily life. Sensing system 3212 mayinclude various types of sensors, not limited to those depicted in FIG.32, depending upon the type of motor task to be performed. Sensors maybe attachable to the subject, e.g. dry electrodes, epidermalelectronics, adherent accelerometers, or cameras; built into or attachedto a wearable item (such as a garment, an item of clothing, an item ofheadwear, an item of j ewelry, a wristband, a headband, a belt, aharness, an item of footwear, an eyeglass, a goggle, or a helmet), orlocated in or on an item of athletic equipment. In various aspects, asensing system includes one or more accelerometer, inclinometer, forcesensor, pressure sensor, motion sensor, temperature sensor, opticalsensor, or EMG sensor. In various aspects, the sensing system includesone or more remote sensor, such as a camera, a scanner, and a Kinect. Inan aspect, sensing system 3212 includes a plurality of sensors (variousexamples of which are described in connection with FIG. 2) adapted tosense a plurality of parameters indicative of performance of the motortask by subject 3202, and performance assessment module 3242 isconfigured to process the plurality of parameters to assess performanceof the motor task by the subject.

Example module 3232 can be configured to control delivery of the exampleof the motor task via one or more of sound source 3210, speaker 3240,display 3236 or display 3224. The example can be an audiovisual examplethat includes both video and sound track (e.g., narration of actions tobe performed), or the example can include only audio or only video. Insome aspects, the example can be delivered via other types of outputdevices, for example, a controllable compression garment, an electricalstimulation device, a force applying device, a vibrotactile device, or ahaptic device. Examples of garments and other wearable items includingcapability for sensing and delivery of stimuli, compression, etc. aredescribed in U.S. Published Patent Application 20160058644 to Cheatham,III et al.; U.S. Published Patent Application 20160015280 to Hyde etal.; U.S. Published Patent Application 20160015972 to Hyde et al.; U.S.Published Patent Application 20160120733 to Ishikawa et al.; U.S.Published Patent Application 20160120734 to Ishikawa et al.; and U.S.Published Patent Application 20160220808 to Hyde et al., all of whichare incorporated herein by reference. Such devices can be used to movethe subject's body, or cause the subject to move his body, so as to aproduce a desired pattern of movement. Similarly, such devices can beused to deliver prompts as well as examples to the subject.

Stimulator driver 3206 can be configured to drive delivery of the neuralstimulus 3214 responsive to an output of the performance assessmentmodule 3242 based at least in part on a comparison of the at least oneparameter with at least one target parameter. For example, in an aspect,the at least one target parameter corresponds to a preferred taskperformance. In an aspect, a selection module (like selection module 418in FIG. 3) is adapted to compare parameters corresponding to two or morehistorical performances of the task by the subject and select at leastone parameter corresponding to at least one best performance of the twoor more historical performances, wherein the preferred task performanceis the at least one best performance. In an aspect, the selection moduleis adapted to compare two or more portions of two or more historicalperformances of the task by the subject, select the best two or moreportions of the two or more historical performances, and combine thebest two or more portions to produce a best combined historicalperformance. In an aspect, sensing system 3212 is adapted to sense aplurality of parameters indicative of performance of the motor task bythe subject, and the performance assessment module 3242 is configured tocompare the plurality of parameters with a plurality of targetparameters. In connection therewith, stimulator driver 3206 isconfigured to drive delivery of neural stimulus 3214 responsive to anoutput of the performance assessment module 3242 based at least in parton a comparison of the plurality of parameters with the plurality oftarget parameters.

FIG. 33 is a flow diagram of a method of training a subject to perform acomplex motor task. Method 3300 includes presenting to a subject, via atleast one of an audio output device and a visual output device undercontrol of a controller of a personal computing device, a primingexample of a complex motor task, the complex motor task includingactivation of a plurality of muscles, as indicated at 3302; instructingthe subject, via at least one of an audio output device and a visualoutput device under control of the controller, to mentally rehearse thecomplex motor task during at least one presentation of a rehearsalexample of the complex motor task, as indicated at 3304; providing tothe subject, via at least one of an audio output device and a visualoutput device under control of the controller, a notification to thesubject of a start of at least one presentation of the rehearsalexample, as indicated at 3306; presenting to the subject, via at leastone of an audio output device and a visual output device under controlof the controller, the rehearsal example, as indicated at 3308;delivering to the subject, via a neural stimulus source under control ofthe controller, a learning enhancing neural stimulus during orimmediately after at least one presentation of the rehearsal example, asindicated at 3310; and repeating, under control of the controller,presenting the rehearsal example to the subject for a training period,as indicated at 3312.

FIG. 34 depicts a method 3400, including further aspects relating topresenting the priming example to the subject. In one aspect, presentingthe priming example includes presenting an audiovisual representation ofthe complex motor task, as indicated at 3402. In another aspect,presenting the priming example includes presenting a visualrepresentation of the complex motor task, as indicated at 3404. Forexample, in an aspect, presenting the visual representation of thecomplex motor task includes presenting a video recording of aperformance of the complex motor task, as indicated at 3406. In anotheraspect, wherein presenting the visual representation of the complexmotor task includes presenting an animation representing one or moreaspects of the complex motor task, as indicated at 3408.

In yet another aspect, presenting the priming example includespresenting an audio sequence corresponding to the complex motor task, asindicated at 3410, wherein the audio sequence corresponding to thecomplex motor task includes, for example, verbal instructions or cuesfor performance of multiple components of multiple components of thecomplex motor task, as indicated at 3412; a plurality of tones orpitches synchronized to sequential components of the complex motor task,as indicated at 3414, or music corresponding to sequential components ofthe complex motor task, as indicated at 3416.

FIG. 35 depicts a method 3500, including further details relating topresenting the rehearsal example to the subject. In one aspect,presenting the rehearsal example includes presenting an audiovisualrepresentation of the complex motor task, as indicated at 3502. Inanother aspect, presenting the rehearsal example includes presenting avisual representation of the complex motor task, as indicated at 3504,e.g. a video recording of a performance of the complex motor task, asindicated at 3506, or an animation representing one or more aspects ofthe complex motor task, as indicated at 3508.

In another aspect, presenting the rehearsal example includes presentingan audio sequence corresponding to the complex motor task, as indicatedat 3510. For example, in various aspects, the audio sequencecorresponding to the complex motor task includes verbal instructions orcues for performance of multiple components of the complex motor task,as indicated at 3512; a plurality of tones or pitches synchronized tosequential components of the complex motor task, as indicated at 3514;or music corresponding to sequential components of the complex motortask, as indicated at 3516. The priming example can be different fromthe rehearsal example, as indicated at 3518, or the same as therehearsal example, as indicated at 3520.

FIG. 36 depicts method 3600, which includes detecting performance of atleast a portion of the complex motor task by the subject with a sensingsystem, as indicated at 3602. In various aspects, detecting performanceof the at least a portion of the complex motor task includes one or moreof detecting performance of a mental activity by the subject, at 3604;detecting performance of a physical activity by the subject, at 3606;detecting performance of two or more related physical or mentalactivities by the subject, at 3608; and detecting a signal with an EEGsensor, an EMG sensor, a motion sensor, a pressure sensor, a forcesensor, an accelerometer, an inclinometer, an implantable sensor, awearable sensor, a sensor carried by the subject, a sensor in or on aninstrument, implement, or article of equipment carried by the subject, aremote camera, or a microphone, at 3610.

In an aspect, method 3600 further includes providing feedback to thesubject with a feedback system regarding performance of the at least aportion of the complex motor task by the subject, at 3612. For example,in various aspects, providing feedback to the subject includes providingfeedback with at least one of a display, a light, a speaker, a vibrator,a force applying element, an electrical stimulator, or an olfactorystimulus source, at 3614.

FIG. 37 depicts method 3700, which includes further aspects relatingdelivery of the learning enhancing stimulus. In an aspect, deliveringthe learning enhancing neural stimulus includes delivering atranscutaneous neural stimulus, at 3702. In various aspects, deliveringthe learning enhancing neural stimulus includes delivering a stimulus toa cranial nerve of the subject, at 3704; a vagal nerve of the subject,at 3706; a trigeminal nerve of the subject, at 3708; or aglossopharyngeal nerve of the subject, at 3710. For example, deliveringthe learning enhancing neural stimulus includes delivering a stimulus toa peripheral neural structure innervating a pinna of the ear of thesubject, at 3712; an ear canal of the ear of the subject, at 3714; or aconcha of the ear of the subject, at 3716.

FIG. 38 depicts method 3800, which includes additional methodvariations. In an aspect, method 3800 includes delivering a secondarystimulus to the subject with a secondary stimulus source, at 3802, e.g.delivering a stimulus with at least one of a TENS unit, a musclestimulator, a nerve stimulator, a mechanical assist device, a mechanicalstimulator, a mechanical restraint, a thermal stimulator, a forceapplying element, an olfactory stimulus source, gustatory stimulussource, a nociceptive stimulus source, a vibrator, or an auditorystimulus source, as indicated at 3804.

In another aspect, method 3800 includes receiving, with an interfacedevice, a control input for setting stimulation parameters forcontrolling delivery of the learning enhancing neural stimulus by theneural stimulus source, at 3806. In other aspects, method 3800 includesat least one of sending a communication from the controller to acomputing or communication network or receiving a communication at thecontroller from the computing or communication network, viacommunication circuitry operably coupled to the controller, at 3808. Instill other aspects, method 3800 includes at least one of providing anoutput to the subject and receiving an input from the subject via a userinterface device, at 3810.

FIG. 39 depicts method 3900 including various method aspects relating toscheduling and tracking of practices sessions. In an aspect, method 3900includes creating a practice session schedule; storing the practicesession schedule in a data storage location operatively coupled to thecontroller; and generating reminders for delivery to the subject via atleast one user interface device operably coupled to controller to remindthe subject of one or more practice sessions from the practice sessionschedule stored in the data storage location, as indicated at 3902. In afurther aspect, method 3900 includes tracking, with a tracking module,practice session data relating to at least one practice session duringwhich the subject practices the complex motor task; and storing thetracked practice session data in the data storage location, as indicatedat 3904. In an aspect, the practice session data includes a time and adate of at least one practice session, as indicated at 3906, or aduration of at least one practice session, as indicated at 3908.

In other aspects, method 3900 includes one or more of generatingpractice session trends or metrics based on one or more tracked practicesessions, as indicated at 3910, and reporting, with reporting circuitry,information regarding one or more tracked practice sessions, practicesession trends, or practice session metrics to one or more of thesubject, a parent, an instructor, a coach, a medical care provider, or apeer, as indicated at 3912. For example, reporting with the reportingcircuitry includes providing reports based on the tracked practicesession data to a scoring module, as indicated at 3914.

In an aspect, method 3900 includes assigning, with a scoring module, ascore or ranking to the subject based on the performance of the subjectduring the one or more tracked practice sessions, at 3916. This mayinclude, for example, assigning, with the scoring module, a score orranking to subject based on subject's performance relative to theperformance of one or more other individuals, at 3918.

In some aspects, method 3900 includes transferring, with a rewardmodule, a reward to the subject account based upon the tracked practicesession data, at 3920, and/or providing positive feedback to the subjectvia a user interface, at 3922.

FIG. 40 depicts method 4000, which includes sensing, with an attentionsensor, at least one parameter indicative of attentiveness of thesubject, at 4002. For example, sensing the at least one parameterindicative of attentiveness of the subject includes sensing a signalwith at least one of an EEG sensor, at 4004; an eye tracking sensor, at4006; an EMG sensor, at 4008; a motion sensor, at 4010; a force sensor,at 4012; a pressure sensor, at 4014; an accelerometer, at 4016; awearable sensor 4018; a remote sensor, 4020; and a camera 4022.

In addition, in a further aspect, method 4000 includes determining, withan attention tracking module operatively connected to the attentionsensor, attentiveness of the subject based on the at least one parameterindicative of attentiveness of the subject, as indicated at 4024. Inaddition, method 4000 may include generating a notification if thesubject is not attentive, at 4026, for example including generating oneor more of an audio alarm tone, a verbal notification, a visiblenotification, a tactile notification, an electronic notification forstorage in a data storage location or an electronic notification fortransmission to at least one additional location, as indicated at 4028.

FIG. 41 shows a computer program product 4100, including at least onenon-transitory computer-readable medium 4102 bearing one or moreinstructions relating to a method as shown in FIG. 33. Non-transitorycomputer-readable medium 4102 bears one or more instructions forpresenting to a subject, via at least one of an audio output device anda visual output device under control of a controller of a personalcomputing device, a priming example of a complex motor task, the complexmotor task including activation of a plurality of muscles; one or moreinstructions for instructing the subject, via at least one of an audiooutput device and a visual output device under control of thecontroller, to mentally rehearse the complex motor task during at leastone presentation of a rehearsal example of the complex motor task; oneor more instructions for providing to the subject, via at least one ofan audio output device and a visual output device under control of thecontroller, a notification to the subject of a start of at least onepresentation of the rehearsal example; one or more instructions forpresenting to the subject, via at least one of an audio output deviceand a visual output device under control of the controller, therehearsal example; one or more instructions for delivering to thesubject, via a neural stimulus source under control of the controller, alearning enhancing neural stimulus during or immediately after at leastone presentation of the rehearsal example; and one or more instructionsfor repeating, under control of the controller, presenting the rehearsalexample to the subject for a training period, as indicated at 4104.Non-transitory computer-readable medium may be, for example, arecordable medium 4106.

For example, in some aspects, non-transitory computer-readable medium4102 bears one or more instructions for creating a practice sessionschedule; one or more instructions for storing the practice sessionschedule in a data storage location operatively coupled to thecontroller; and one or more instructions for generating reminders fordelivery to the subject via at least one user interface device operablycoupled to controller to remind the subject of one or more practicesessions from the practice session schedule stored in the data storagelocation, corresponding to aspects of method 3900 in FIG. 39.

In some aspects, non-transitory computer-readable medium 4102 bears oneor more instructions for tracking, with a tracking module, practicesession data relating to at least one practice session during which thesubject practices the complex motor task; and one or more instructionsfor storing the tracked practice session data in a data storagelocation, also corresponding to aspects of method 3900 in FIG. 39.

In other aspects, non-transitory computer-readable medium 4102 bearsinstructions pertaining to various of the method steps depicted in FIGS.33-40.

In a general sense, the various embodiments described herein can beimplemented, individually and/or collectively, by various types ofelectrical circuitry having a wide range of electrical components suchas hardware, software, firmware, and/or virtually any combinationthereof. Electrical circuitry (including electrical control circuitry208 in FIGS. 2 and 3, for example) includes electrical circuitry havingat least one discrete electrical circuit, electrical circuitry having atleast one integrated circuit, electrical circuitry having at least oneapplication specific integrated circuit, electrical circuitry forming acomputing device configured by a computer program (e.g., a computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g. data storage location 244 in FIG. 3), which mayinclude various types of memory (e.g., random access, flash, read only,etc.)), electrical circuitry forming a communications device (e.g.,communication circuitry 430 in FIG. 3) (e.g., a modem, communicationsswitch, optical-electrical equipment, etc.), and/or any non-electricalanalog thereto, such as optical or other analogs (e.g., graphene basedcircuitry). In an embodiment, the system is integrated in such a mannerthat the system operates as a unique system configured specifically forfunction of the neural stimulation system described herein. In anembodiment, one or more associated computing devices of the systemoperate as specific use computers for purposes of the claimed system,and not general use computers. In an embodiment, one or more of theassociated computing devices of the system are hardwired with a specificROM to instruct the one or more computing devices.

In a general sense, the various aspects described herein which can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, and/or any combination thereof can beviewed as being composed of various types of “electrical circuitry.”

At least a portion of the devices and/or processes described herein canbe integrated into a data processing system. A data processing systemgenerally includes one or more of a system unit housing, a videodisplay, memory such as volatile or non-volatile memory, processors suchas microprocessors or digital signal processors, computational entitiessuch as operating systems, drivers, graphical user interfaces, andapplications programs, one or more interaction devices (e.g., a touchpad, a touch screen, an antenna, etc.), and/or control systems includingfeedback loops and control motors (e.g., feedback for sensing positionand/or velocity; control motors for moving and/or adjusting componentsand/or quantities). A data processing system may be implementedutilizing suitable commercially available components, such as thosetypically found in data computing/communication and/or networkcomputing/communication systems.

In various embodiments, methods as described herein may be performedaccording to instructions implementable in hardware, software, and/orfirmware. Such instructions may be stored in non-transitorymachine-readable data storage media, for example. The state of the arthas progressed to the point where there is little distinction leftbetween hardware, software, and/or firmware implementations of aspectsof systems; the use of hardware, software, and/or firmware is generally(but not always, in that in certain contexts the choice between hardwareand software can become significant) a design choice representing costvs. efficiency tradeoffs. There are various vehicles by which processesand/or systems and/or other technologies described herein can beeffected (e.g., hardware, software, and/or firmware), and that thepreferred vehicle will vary with the context in which the processesand/or systems and/or other technologies are deployed. For example, ifan implementer determines that speed and accuracy are paramount, theimplementer may opt for a mainly hardware and/or firmware vehicle;alternatively, if flexibility is paramount, the implementer may opt fora mainly software implementation; or, yet again alternatively, theimplementer may opt for some combination of hardware, software, and/orfirmware in one or more machines, compositions of matter, and articlesof manufacture. Hence, there are several possible vehicles by which theprocesses and/or devices and/or other technologies described herein maybe effected, none of which is inherently superior to the other in thatany vehicle to be utilized is a choice dependent upon the context inwhich the vehicle will be deployed and the specific concerns (e.g.,speed, flexibility, or predictability) of the implementer, any of whichmay vary. Optical aspects of implementations will typically employoptically-oriented hardware, software, and or firmware.

In some implementations described herein, logic and similarimplementations may include software or other control structures.Electrical circuitry, for example, may have one or more paths ofelectrical current constructed and arranged to implement variousfunctions as described herein. In some implementations, one or moremedia may be configured to bear a device-detectable implementation whensuch media hold or transmit device detectable instructions operable toperform as described herein. In some variants, for example,implementations may include an update or modification of existingsoftware or firmware, or of gate arrays or programmable hardware, suchas by performing a reception of or a transmission of one or moreinstructions in relation to one or more operations described herein.Alternatively or additionally, in some variants, an implementation mayinclude special-purpose hardware, software, firmware components, and/orgeneral-purpose components executing or otherwise invokingspecial-purpose components.

Implementations may include executing a special-purpose instructionsequence or invoking circuitry for enabling, triggering, coordinating,requesting, or otherwise causing one or more occurrences of virtuallyany functional operations described herein. In some variants,operational or other logical descriptions herein may be expressed assource code and compiled or otherwise invoked as an executableinstruction sequence. In some contexts, for example, implementations maybe provided, in whole or in part, by source code, such as C++, or othercode sequences. In other implementations, source or other codeimplementation, using commercially available and/or techniques in theart, may be compiled//implemented/translated/converted into a high-leveldescriptor language (e.g., initially implementing described technologiesin C or C++ programming language and thereafter converting theprogramming language implementation into a logic-synthesizable languageimplementation, a hardware description language implementation, ahardware design simulation implementation, and/or other such similarmode(s) of expression). For example, some or all of a logical expression(e.g., computer programming language implementation) may be manifestedas a Verilog-type hardware description (e.g., via Hardware DescriptionLanguage (HDL) and/or Very High Speed Integrated Circuit HardwareDescriptor Language (VHDL)) or other circuitry model which may then beused to create a physical implementation having hardware (e.g., anApplication Specific Integrated Circuit).

This detailed description sets forth various embodiments of devicesand/or processes via the use of block diagrams, flowcharts, and/orexamples. Insofar as such block diagrams, flowcharts, and/or examplescontain one or more functions and/or operations, each function and/oroperation within such block diagrams, flowcharts, or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof. Inan embodiment, several portions of the subject matter described hereinmay be implemented via Application Specific Integrated Circuits (ASICs),Field Programmable Gate Arrays (FPGAs), digital signal processors(DSPs), or other integrated formats. However, some aspects of theembodiments disclosed herein, in whole or in part, can be equivalentlyimplemented in integrated circuits, as one or more computer programsrunning on one or more computers (e.g., as one or more programs runningon one or more computer systems), as one or more programs running on oneor more processors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, the mechanisms ofthe subject matter described herein are capable of being distributed asa program product in a variety of forms, and that an illustrativeembodiment of the subject matter described herein applies regardless ofthe particular type of computer-readable medium used to actually carryout the distribution. Examples of a computer-readable medium include,but are not limited to non-transitory machine-readable data storagemedia such as a recordable type medium such as a floppy disk, a harddisk drive, a Compact Disc (CD), a Digital Video Disk (DVD), a digitaltape, a computer memory, etc.. A signal bearing medium may includetransmission type medium such as a digital and/or an analogcommunication medium (e.g., a fiber optic cable, a waveguide, a wiredcommunications link, a wireless communication link (e.g., transmitter,receiver, transmission logic, reception logic, etc.) and so forth).

The herein described subject matter sometimes illustrates differentcomponents contained within, or connected with, different othercomponents. It is to be understood that such depicted architectures aremerely examples, and that in fact many other architectures may beimplemented which achieve the same functionality. In a conceptual sense,any arrangement of components to achieve the same functionality iseffectively “associated” such that the desired functionality isachieved. Hence, any two components herein combined to achieve aparticular functionality can be seen as “associated with” each othersuch that the desired functionality is achieved, irrespective ofarchitectures or intermedial components. Likewise, any two components soassociated can also be viewed as being “operably connected”, or“operably coupled,” to each other to achieve the desired functionality,and any two components capable of being so associated can also be viewedas being “operably couplable,” to each other to achieve the desiredfunctionality. Specific examples of operably couplable include but arenot limited to physically mateable and/or physically interactingcomponents, and/or wirelessly interactable, and/or wirelesslyinteracting components, and/or logically interacting, and/or logicallyinteractable components.

In some instances, one or more components may be referred to herein as“configured to,” “configured by,” “configurable to,” “operable/operativeto,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc.Those skilled in the art will recognize that such terms (e.g.,“configured to”) generally encompass active-state components and/orinactive-state components and/or standby-state components, unlesscontext requires otherwise.

While particular aspects of the present subject matter described hereinhave been shown and described, it will be apparent to those skilled inthe art that, based upon the teachings herein, changes and modificationsmay be made without departing from the subject matter described hereinand its broader aspects and, therefore, the appended claims are toencompass within their scope all such changes and modifications as arewithin the true spirit and scope of the subject matter described herein.It will be understood by those within the art that, in general, termsused herein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations. In addition, evenif a specific number of an introduced claim recitation is explicitlyrecited, those skilled in the art will recognize that such recitationshould typically be interpreted to mean at least the recited number(e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “ a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “ a system having atleast one of A, B, or C” would include but not be limited to systemsthat have A alone, B alone, C alone, A and B together, A and C together,B and C together, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flows are presented in asequence(s), it should be understood that the various operations may beperformed in other orders than those which are illustrated, or may beperformed concurrently. Examples of such alternate orderings may includeoverlapping, interleaved, interrupted, reordered, incremental,preparatory, supplemental, simultaneous, reverse, or other variantorderings, unless context dictates otherwise. Furthermore, terms like“responsive to,” “related to,” or other past-tense adjectives aregenerally not intended to exclude such variants, unless context dictatesotherwise.

While various aspects and embodiments have been disclosed herein, otheraspects and embodiments will be apparent to those skilled in the art.The various aspects and embodiments disclosed herein are for purposes ofillustration and are not intended to be limiting, with the true scopeand spirit being indicated by the following claims.

What is claimed is:
 1. A system for enhancing learning of an activity,comprising: a housing configured to fit in or on at least a portion ofan ear of a subject; a neural stimulator located in or on the housingand configured to deliver a transcutaneous neural stimulus to aperipheral neural structure located at least in part in or on the ear ofthe subject; a prompting system configured to deliver at least oneprompt for prompting the subject to repeatedly perform a specificactivity; and electrical control circuitry including stimulator controlcircuitry adapted to generate at least one stimulus control signal forcontrolling delivery of the transcutaneous neural stimulus to theperipheral neural structure with the neural stimulator; prompter controlcircuitry adapted to generate at least one prompt control signal forcontrolling delivery of the prompt by the prompting system; and timingcontrol circuitry for controlling a number of repetitions of thespecific activity that the subject is prompted to perform by the atleast one prompt and timing of delivery of the transcutaneous neuralstimulus with respect to the at least one prompt. 2.-33. (canceled) 34.The system of claim 1, wherein the prompting system includes two or moreof a display, a light, a speaker, a vibrator, a force-applying element,a mechanical stimulator, an electrical stimulator, an electromagneticstimulator, a thermal stimulator or an olfactory stimulus source. 35.The system of claim 1, including a sensing system for detectingperformance of the activity by the subject. 36.-38. (canceled)
 39. Thesystem of claim 35, wherein the sensing system includes at least one ofan EEG sensor, and EMG sensor, an oxygenation sensor, a motion sensor, apressure sensor, a force sensor, an accelerometer, an inclinometer, animplantable sensor, a wearable sensor, a sensor carried by the subject,a sensor in or on an instrument, implement, or article of equipmentcarried by the subject, a remote camera, and a microphone. 40.-42.(canceled)
 43. The system of claim 1, wherein the housing and the neuralstimulator are configured to a deliver a transcutaneous neural stimulusto a cranial nerve of the subject. 44.-49. (canceled)
 50. The system ofclaim 1, further comprising a secondary stimulus source. 51.-64.(canceled)
 65. A method of enhancing learning, comprising: delivering,with a neural stimulator housed in a housing fitted in or on at least aportion of an ear of a subject, a transcutaneous neural stimulus to aperipheral neural structure located at least in part in or on the ear ofa subject, wherein the neural stimulator is controlled by electricalcontrol circuitry operably coupled to the neural stimulator; delivering,with a prompting system under control of the electrical controlcircuitry, at least one prompt to the subject for prompting the subjectto repeatedly perform a specific activity, wherein the electricalcontrol circuitry is operably coupled to the prompting system;controlling, with the electrical control circuitry a timing of deliveryof the transcutaneous neural stimulus with respect to the at least oneprompt; and a number of repetitions of the specific activity that thesubject is prompted to perform by the at least one prompt. 66.-90.(canceled)
 91. The method of claim 65, including detecting performanceof the activity by the subject with a sensing system. 92.-95. (canceled)96. The method of claim 91, including providing feedback to the subjectwith a feedback system regarding performance of the activity by the subject. 97.-106. (canceled)
 107. The method of claim 65, includingdelivering a secondary stimulus to the subject with a secondary stimulussource. 108.-112. (canceled)
 113. The method of claim 65, includingtracking, with a tracking module, practice session data relating to atleast one practice session during which the subject practices theactivity; and storing the tracked practice session data in a datastorage location. 114.-121. (canceled)
 122. A computer program product,comprising: at least one non-transitory computer-readable medium bearingone or more instructions for generating, under control of electricalcontrol circuitry, a least one stimulus control signal for controllingdelivery of a transcutaneous neural stimulus to a peripheral neuralstructure located at least in part in or on an ear of a subject via aneural stimulator fitted in or on at least a portion of the ear of asubject; one or more instructions for delivering, via a prompting systemunder control of the electrical control circuitry, at least one promptfor prompting the subject to repeatedly perform a specific activity; oneor more instructions for controlling a timing of delivery of thetranscutaneous neural stimulus with respect to the at least one prompt;and one or more instructions for controlling a number of repetitions ofthe specific activity that the subject is prompted to perform by the atleast one prompt. 123.-126. (canceled)
 127. The computer program productof claim 122, wherein the at least one non-transitory computer-readablemedium bears one or more instructions for creating a practice sessionschedule; one or more instructions storing the practice session schedulein a data storage location operatively coupled to the electrical controlcircuitry; and one or more instructions for generating reminders fordelivery to the subject via at least one user interface device operablycoupled to the control circuitry to remind the subject of one or morepractice sessions from the practice session schedule stored in the datastorage location.
 128. The computer program product of claim 122,wherein the at least one non-transitory computer-readable medium bearsone or more instructions for tracking, with a tracking module, practicesession data relating to at least one practice session during which thesubject practices the activity; and one or more instructions for storingthe tracked practice session data in a data storage location. 129.-131.(canceled)
 132. The computer program product claim 128, wherein the atleast one non-transitory computer-readable medium bears one or moreinstructions for reporting, with reporting circuitry, informationregarding one or more tracked practice sessions, practice sessiontrends, or practice session metrics to one or more of the subject, aparent, an instructor, a coach, a medical care provider, a peer, or acomputing system. 133.-136. (canceled)
 137. A system for enhancinglearning, comprising: a noninvasive device for stimulating a cranialnerve of a subject, the device including at least one transcutaneousneural stimulator; at least one neural sensor adapted to sense at leastone neural activity of the subject; a prompting system configured todeliver at least one prompt for prompting the subject to repeatedlyperform a specific activity; and electrical control circuitry includingstimulator control circuitry adapted to generate at least one stimuluscontrol signal for controlling delivery of a transcutaneous neuralstimulus to the cranial nerve with the transcutaneous neural stimulator;prompter control circuitry adapted to generate at least one promptcontrol signal for controlling delivery of the prompt by the promptingsystem; and timing control circuitry for controlling a number ofrepetitions of the specific activity that the subject is prompted toperform by the at least one prompt and timing of delivery of thetranscutaneous neural stimulus with respect to the at least one prompt.138.-162. (canceled)
 163. The system of claim 137, including electrodesfor stimulating muscles. 164.-170. (canceled)
 171. The system of claim1, wherein the prompting system includes at least one of a visiblesignal source, a speaker, a display, personal computing device, anelectrical stimulator, an electromagnetic stimulator, a thermalstimulator, a mechanical stimulator, a vibrator, a force-applyingelement, or an olfactory stimulus source.
 172. The system of claim 1,wherein the prompting system is located at least in part in or on thehousing; wherein the prompting system is configured as a wearable item;or wherein the prompting system is configured for attachment to ormounting in or on an instrument, implement, article of equipment, orarticle of clothing.
 173. The system of claim 35, wherein the sensingsystem is adapted to detect performance of a mental activity, a physicalactivity, or two or more related physical or mental activities by thesubject.
 174. The system of claim 35, including at least one of aperformance assessment module configured to evaluate performance of theactivity by the subject or a performance feedback system configured toprovide feedback to the subject regarding performance of the activity bythe subject.
 175. The system of claim 1, wherein the housing isconfigured to fit at least in part on a pinna of the ear of the subject,into an ear canal of the ear of the subject, or into a concha of the earof the subject.
 176. The system of claim 1, further comprising at leastone of a secondary stimulus source; communication circuitry forproviding communication between the electrical control circuitry and acomputing or communication network; at least one user interface devicefor at least one of providing an output to the subject and receiving aninput from the subject; a scheduling module for creating a practicesession schedule and generating reminders to remind the subject of oneor more practice sessions from the practice session schedule stored; atracking module configured to track practice sessions during which thesubject practices the activity and to store tracked practice sessiondata in a data storage location; reporting circuitry for reportinginformation regarding one or more tracked practice sessions, practicesession trends, or practice session metrics to one or more of thesubject, a parent, an instructor, a coach, a medical care provider, apeer, or a computing system; or a reward module for transferring areward to the subject account based upon one or more tracked practicesession.
 177. The method of claim 65, including controlling the timingof delivery of the transcutaneous neural stimulus with respect to the atleast one prompt to deliver the transcutaneous neural stimulus prior tothe at least one prompt, deliver the transcutaneous neural stimulussubsequent to the at least one prompt, or deliver the transcutaneousneural stimulus to overlap at least partially in time with delivery ofthe at least one prompt.
 178. The method of claim 65, whereincontrolling the number of repetitions of the specific activity that thesubject is prompted to perform includes controlling delivery of oneprompt for each of the number of repetitions; controlling delivery of afirst prompt that informs the subject of the number of repetitions and asecond prompt that is repeated once for each of the number ofrepetitions; controlling delivery of a first prompt that informs thesubject of the specific activity that is to be performed and a secondprompt that is repeated once for each of the number of repetitions; orcontrolling delivery of the at least one prompt at a fixed rate for afixed period of time.
 179. The method of claim 65, wherein deliveringthe at least one prompt includes at least one of delivering an audibleprompt, delivering a visible prompt, delivering an audio-visual prompt,delivering a tactile prompt, delivering a haptic prompt, delivering anelectrical stimulus, delivering the at least one prompt via a speaker,or delivering the at least one prompt via a display.
 180. The method ofclaim 65, wherein delivering the at least one prompt includes at leastone of delivering the at least one prompt via a personal computingdevice; delivering the at least one prompt via a wearable item;delivering the at least one prompt via a prompting system attached to ormounted in or on an instrument, implement, article of equipment, orarticle of clothing; or delivering the at least one prompt via two ormore of a display, a light, a speaker, a vibrator, an electricalstimulator, and an olfactory stimulus source.
 181. The method of claim91, wherein detecting performance of the activity includes at least oneof detecting performance of a mental activity by the subject; detectingperformance of a physical activity by the subject; detecting performanceof two or more related physical or mental activities by the subject;detecting a signal with an EEG sensor; detecting a signal with an EMGsensor; detecting a signal with an oxygenation sensor; detecting asignal with a motion sensor; detecting a signal with a pressure sensor;detecting a signal with a force sensor; detecting a signal with anaccelerometer; detecting a signal with an inclinometer; detecting asignal with an implantable sensor; detecting a signal with a wearablesensor; detecting a signal with a sensor carried by the subject; ordetecting a signal with a sensor in or on an instrument, implement, orarticle of equipment carried by the subject; detecting a signal with aremote camera, or detecting a signal with a microphone.
 182. The methodof claim 65, wherein the transcutaneous neural stimulus is alearning-enhancing stimulus or a memory-blocking stimulus.
 183. Themethod of claim 65, including delivering the transcutaneous neuralstimulus to at least one of a cranial nerve of the subject, a vagalnerve of the subject, a trigeminal nerve of the subject, aglossopharyngeal nerve of the subject, a peripheral neural structureinnervating a pinna of the ear of the subject, a peripheral neuralstructure innervating an ear canal of the ear of the subject, or aperipheral neural structure innervating a concha of the ear of thesubject.
 184. The method of claim 65, including at least one ofreceiving, with an interface device, a control input for settingstimulation parameters; sending a communication from the electricalcontrol circuitry to a computing or communication network viacommunication circuitry operably coupled to the electrical controlcircuitry; receiving a communication at the electrical control circuitryfrom the computing or communication network via communication circuitryoperably coupled to the electrical control circuitry; providing anoutput to the subject via a user interface device; and receiving aninput from the subject via a user interface device.
 185. The method ofclaim 65, including creating a practice session schedule; storing thepractice session schedule in a data storage location operatively coupledto the electrical control circuitry; and generating reminders fordelivery to the subject via at least one user interface device operablycoupled to the control circuitry to remind the subject of one or morepractice sessions from the practice session schedule stored in the datastorage location.
 186. The method of claim 113, including at least oneof generating practice session trends or metrics based on one or moretracked practice sessions; reporting, with reporting circuitry,information regarding one or more tracked practice sessions, practicesession trends, or practice session metrics to one or more of thesubject, a parent, an instructor, a coach, a medical care provider, apeer, or a computing system; providing reports based on the trackedpractice session data to a scoring module; assigning, with the scoringmodule, a score or ranking to the subject based on the performance ofthe subject during the one or more tracked practice sessions; assigning,with the scoring module, a score or ranking to the subject based on thesubject's performance relative to the performance of one or more otherindividuals; or transferring, with a reward module, a reward to thesubject account based upon the tracked practice session data.
 187. Thecomputer program product of claim 122, wherein the at least onenon-transitory computer-readable medium bears at least one of one ormore instructions for receiving, with an interface device, a controlinput for setting stimulation parameters; one or more instructions forsending a communication from the electrical control circuitry to acomputing or communication network, via communication circuitry operablycoupled to the electrical control circuitry; one or more instructionsfor receiving a communication at the electrical control circuitry from acomputing or communication network, via communication circuitry operablycoupled to the electrical control circuitry; or one or more instructionsfor providing an output to the subject or receiving an input from thesubject via a user interface device.
 188. The computer program productof claim 128, wherein the one or more instructions for storing thetracked practice session data in the data storage location include oneor more instructions for storing at least one of a time, a date, or aduration of at least one practice session; wherein the at least onenon-transitory computer-readable medium bears one or more instructionsfor generating practice session trends or metrics based on one or moretracked practice sessions; or wherein the at least one non-transitorycomputer-readable medium bears one or more instructions fortransferring, with a reward module, a reward to the subject accountbased upon the tracked practice session data.
 189. The computer programproduct of claim 132, wherein the one or more instructions for reportingwith the reporting circuitry include one or more instructions forproviding reports based on the tracked practice session data to ascoring module; wherein the at least one non-transitorycomputer-readable medium bears one or more instructions for assigning,with the scoring module, a score or ranking to the subject based on theperformance of the subject during the one or more tracked practicesessions; or wherein the at least one non-transitory computer-readablemedium bears one or more instructions for assigning, with the scoringmodule, a score or ranking to the subject based on the subject'sperformance relative to the performance of one or more otherindividuals.
 190. The system of claim 137, wherein the transcutaneousneural stimulator includes at least one of an earbud, a TENS unit, or apatch electrode.
 191. The system of claim 137, wherein the promptingsystem is configured to deliver the at least one prompt for promptingthe subject to perform at least one of a mental task, a cognitive task,a memory task, a recall task, a motor task, a motor task relating tomotor skill learning, a motor task relating to motor memory, a taskrelating to reducing a neuropathy, or a task relating to reducing anautonomic neuropathy.